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2795 2nd Street,Suite 300 <br /> CA 18 KIF "j <br /> LabDavis. 956 4800 SRG#1 Lab No. / J Page of <br /> /�nW Lx Fax: 530.297.4802 <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑Yes ❑W Chain-of-Custody Record and Analysis Request <br /> MA,a n.co b AU <br /> Company!Address: Sampling Company Log Code: Analysis Re uest TAT <br /> Tie: (�C 0 1 - t 4 CIRCLE HMOD ❑ <br /> Pho a Np� ber: ! — Global ID: 12 hr <br /> 6)4 <br /> FFct <br /> t. 7 EDF Deliverable To(Email Address): g <br /> G u� <br /> PP.O.#: aiil lo:TETLkw t A— 1 T i; i C � 24 hr0�'� Ley SCY� L c1 w a 8 <br /> Project N1 ame: r !! Sampler Print Name: C- w m c v ❑ <br /> Ccx'� 0.1�ck Ld tsr.f+p/1AL m a m 0 48hr o <br /> 1 4 _ <br /> Sampler Signature: p w m w N in LL <br /> 'l f �C101+t p g w j Q $ i <br /> Project Address: Sampling ntainer Preservative Matrix w o a a V a a r g a.- ❑ <br /> (Z4ZZE �' �rx,)�1' m 72hr <br /> C"tC [AWt1 � a is a a <br /> E m 0 U z 'u a o a w .1 1w <br /> Samoa Desi nation Date Time co a i3 t— z z m -' r "' }' <br /> xc_ V ! 07112 J1 � ok <br /> GLC-- G 'Z �r /' � 0[ <br /> C� C _ o -3 �� " X 01 <br /> C1c - O � Ir � <br /> d( <br /> 0"2 <br /> rr �.' 1 4 <br /> Relinqu d by: Date Time Received by: Remarks: <br /> 1[Hlo ,.�v <br /> linquished by: Date Time Received by: <br /> ----------------- <br /> elinqutshed by: Date Time ReceiveW—�'t <br /> 1Z Ga �l�C <br /> DisVihudw White-Lab:Pink-originator <br /> Rev:080408 <br />