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JCCFFCAL 720 Olive Drive,Suite D Lab 916 297 4800 C I e <br /> LLC Davis,CA 95616 Fax 916 297 4808 z 1 S <br /> Project Manager Phone No Chain-of-Custody Record and Analysis Request <br /> r � � q_ <br /> Company/Address 15104rA04 'x,5 , t�� FAX No Analysis Request c�� W" For Lab <br /> Use Only <br /> i c ! -D8 W <br /> Protect Number PO No Protect Name WE T(X) <br /> 1 G p TOTAL(X) N <br /> Project Location qV0 N+fr D0r4dD ft, Sampler Signature 3 <br /> L <br /> W o r <br /> Container Method o a <br /> Sampling (Type/Amount) Preserved Matrix N o y m N z r <br /> w o d CL m N N <br /> U) o o p 0 0 4 <br /> O ... <br /> Sample a W o Z � s a s Q Q � " r <br /> Designation Date Time o to � r = U z m ao w w w w w u r <br /> 60— 1 , 01 f - -z <br /> Relinquished by Date Time Received by Remarks <br /> fg-zf <br /> Relinquished by Date Time Received by Email address <br /> ❑ doc ❑ As ❑ txt ❑other <br /> ReWriquyshed by Date Time Received by Laboratory Z Z J Bill to <br /> Dutnbution Yt de-Lab, Yellow-Fide Pink-Onginator COC th5 <br />