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Exceleek, 500 Giuseppe Court, Suite 3 <br /> Roseville CA 95678 C .N-OF-CUSTODY RECORD AND ANALYSIS REQUE <br /> Environmental Labs Ph 916 773 3664 Fx 916-773-4784 <br /> Project Manager Phone,4 Electronic Data Deliverables Request <br /> Global I D # TU(0 v 77 U!�:) -/-3'0 Email Address <br /> VI CCOC # <br /> Company/Address Fax# Location I D # <br /> ANALYSIS REQUEST Pae of <br /> Project Number/P O# Project flame Blgl <br /> 99 D I� 01- C'E� hi ai1� "' m <br /> o o Total Due D to <br /> Project Location Sampler Signat re o 04 N w C f, <br /> r" G -77 <br /> N // co p v <br /> cin U <br /> Sampling Container Method Matrix E a m N Q <br /> Preserved <br /> �, �- co m o r <br /> N Dl Q O ( N <br /> Sample O N - � C0 C Q - w Zi Z i- <br /> cnu p w cLp N of L N <br /> (7 N N w m V i— <br /> ID Date Time w n a o o °_� o = a o w 0 a <br /> r j � cn M w w w cn m 0 LL cn p ri ai <br /> O w �u U �z w 0 a 0 iw- a a o m U 0 O m `�° E U a LAB USE <br /> cn r 0- _ = U z rn ¢ co F- i- a a Ln � cn U U Cr ONLY <br /> v>,- 7 <br /> Relinquished by Date Time Received by Remarks/Condition of Sample <br /> Relinquished by Date Time Received by <br /> I <br /> Relinquished by D to Time Received by Laboratry Bill To <br />