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3 <br /> C, <br /> 2795 2nd Street, Suite 340 <br /> .�� Davis,CA 95616 <br /> Lab: 534.297.4844 <br /> ANALY'T/CAL,LLc Fax: 530.297.4808 Lab No3ab—LGr Page of <br /> Project Contact(Hardcopy or PDF To): _ California EDF.Report? ❑ Yes o <br /> RHAJ W Chain=of-Custody Record and Analysis Request <br /> Company/Address: Rown iWXW bttnot mwAdwy to mroiew u,ts>, L <br /> Sampling Company Lop Code: �- <br /> Af�c AJO koTeH � S Analysis Request � <br /> Phone No.: FAX Noy/{:�.//�/1 �yj Global ID: m x <br /> C3 0 cm <br /> CD co <br /> Project Number, P.O. No: EDF Dellverable ma dress): 2 ° °p>11m o T <br /> Ol 00W CO " o <br /> Pr 'ect Name: �y j Sampler Sign t e: "' ? �Wg mg m � o r <br /> Owe, Pie C V� X X c � <br /> N C1 e C <br /> Project Address: <br /> Sampling Container Prescrvative Matrixin q a n -a BN Tog C if aq °� y J <br /> 10 <br /> O W m 1mg� C 0L Cmc m t�} O T L �L <br /> W tj LU Z H J X W W [7 m [n O� Cn m m N <br /> Sample Desi rtatl0ll Date Time v _ _ z m rn xT0. ma a m a zi N <br /> -0LI08— X1$•03 3�DD <br /> f <br /> Relinq sh b Date Time Received by: Remarks: <br /> Relinquish by: ' Date Time Received by: <br /> hod Data Timeeceived by Laboratory: ill to: <br /> �' , <br /> Distribuflon: While-Lab, Yellow-File,Pink-Originator Forms/coc 121007.fh9 <br />