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NALYTICAL 720 Olive Drive,Suite D Lab: 916.297.4800 <br /> LLC Davis,CA 95616 Fax: 916.297.4808 Page of <br /> Projec anager: Phone No.: <br /> r �� - 593-9-2-170 Chain-of-Custody Record and Analysis Request <br /> Comp ny/A s: FAX No.: For Lab <br /> ir ---2-17L Analysis Request Use Only <br /> roject Numbef.. PO. No.: Project Nam 'pV fvt 7 <br /> 3001 1 Z !Ce p ` 3 <br /> Project Location: S ple ignature: N TOTAL(X) <br /> C Co <br /> Co <br /> W u7 C N L <br /> CID <br /> C ntain Method a <br /> Sampling (Type/Amount) Preserved Matrix _ — U <br /> m O d U co m <br /> N a a N N v <br /> Q N o L <br /> w (Ina o o r <br /> N N N Q Q N N ^ N <br /> Sample w w w X � � mComm <br /> P aw " n UZwo Q � � CL(LCL � � � � N <br /> Designation Date Time J r Ln T- U z <br /> S S'GPI z �,�- op 1 <br /> 5 - 15- 1 mss° ! 5 ✓ ✓ r� ? <br /> s - :51 <br /> _a¢ <br /> -S --6)07- iso 1 <br /> -10-6P2- of'w 1 S -o <br /> S -IS --CSP z vY3v l V s ✓ -07 <br /> S - Zp --&F Z- oY4o 5 - 0 g <br /> .s /D GP3 090V <br /> elinqui d by: Date Time Received by: Remarks: <br /> r'i 4 r),1Q <br /> elinquish Lj <br /> y: D e Time Received by: Email address: <br /> ❑.doc ❑.xls ❑.txt ❑other <br /> Relinquished by: Date Time eived by Laboratory: Bill to: <br /> Oistnbution: ife-Lab. Yellow-File,Pink-Originator COC.fh5 <br />