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2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL LLc Fax: 530.297.4808 Lab No. Page of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑ Yes [-]No Chain-of-Custody Record and Analysis Request <br /> u <br /> pany/Address: �1/ c ✓S�–yv� � "°t `° 4°" �- <br /> Sampling Company Log Code: Analysis Request <br /> Q <br /> Y q � <br /> X <br /> Phone No.: FAX No.: Global ID: o <br /> 15;1,1, GJ8-B3�S� o o N w <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): �_ ° m m o 3 <br /> XX W m X C <br /> • m O W W N ♦'� <br /> o uj w m d Q m <br /> Project Name: /1 �J Sam�ignatu W o 00 W M ca o �, W o <br /> to <br /> 00 Co 0 0 co <br /> 2 Co p -� N W <br /> Project Address: Sampling tainer Preservative Matrix � o w N N N m N , 8 °; <br /> ��J �•�T�/ T�-�/ Q m = m O m 10 l0 N C > m W N LL <br /> O w o a H c c m x <br /> > > �, W W ~ m cNa 0 rn rn rn to w m C <br /> E w O Z F- J X x S � x v ¢ .@ v <br /> U z w 0 Q O W = _ = 0 0 0 0 m <br /> Sample Designation Date Time a � _ _ z rn m m r w > <br /> /33 <br /> �- 'e.� I —7L—T 7, 74 <br /> IT <br /> II <br /> S <br /> Relinquished by: Date Time Received by: Remarks: <br /> Relin y: M/Da:tTn,: eived by: <br /> ' quished ty: eive by Laborato,�� !lt ^ Bill to: <br /> 'l /— <br /> Distribution: White-Lab, Pink-Originator Forms/coc 121001.fh9 <br />