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j <br /> 2795 2nd Street, Suite 300 <br /> Lab:Davis,30 97..4800 <br /> ANALYTICAL I LC Fax: 530.297.4808 Lab Nn. d Page of <br /> Projectt}onta�(Hardcopo rrP,DFTo). California EDF Report? ❑ Yes _ o <br /> �!T N ti Chain-of-Custody Record and Analysis Request <br /> Company/Address: ROW mm.iedWnot marKhtWy to 11185actlam, <br /> A� <br /> Sampling Company Log Code: H N(1/�-Or��� Analysis Request � <br /> Phone <br /> 9jNo.- FAX NoGlobal ID: m <br /> 5z <br /> A,-)1-Oly 1GBI- 1 o <br /> Project Number P.O. No 3iv EDFDelbleTo(EAddress): <br /> U7 •OQ _. <br /> — <br /> W W to N - <br /> Project Name: Sampler Sin a m w <br /> N ca r t [6 <br /> m m � a <br /> PE o�Evm m — - a <br /> a g m C9 M 0 (C 4 m ~ N <br /> N U C ` <br /> Project Address: — a aco <br /> a N <br /> SW�j^, �/� /+ Sampling Conta r Preservative Matrix © �Z t- w t N V <br /> l A i * a m c� H F �Wn0 h m , L <br /> I O � C14 M AR 0 m Q m C C c y 4 T N c` lL <br /> W 0 Z F -a X <br /> Sample Designation Date Time v � WL x z a `� a a a. 0 0 o m a m Z <br /> 1 — fL m }- F- �Ci n u7 r J W J <br /> FE 11:00 1 A 01 <br /> TIT <br /> Relin ui b,: Date Time Received by: Remarks: <br /> Relinquis Date Time Received by: <br /> Relin Us a Date Time eceived by Laboratory: Bill to: <br /> 0`13 <br /> Distribution: Mite-Lab,Yellow-File,Pink-Originator I <br /> Fonnslcoc 121001.th9 <br />