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5 Z <br /> TA <br /> � 2795 2nd Street Suite 300 <br /> Davis,CA 95818 <br /> Lab:530.297.4800 Lb ���. Page i of 1 <br /> NALYTICAL ccc Fax:530.297.4808 <br /> Project Contact(Hardcopy or PDF To): Chain-of-Custody Record and Analysis Request <br /> Rich Johnson California EDS' Report? ❑yes No <br /> Company lAddress: ecommendedbut not-ma <br /> ndatory to complete this section: Analysis Request i= <br /> Apex Envirotech,Inc. Sampling Company Log Code; Q <br /> 11244 Pyrites Wy..Gold River,CA 95670 T !— <br /> Phone No.: Fax No.: Global ID; I <br /> 0° � 12h1 <br /> 916-851-0174 916-851-0177 T0607700183 F O <br /> Project Number: i'.O. No.: EDF Deliverable To{Entail Address): m in Ui <br /> . <br /> ERA02A04 r ohnson a exenvirotech.com m o 0 o N O r c <br /> Project Name: w O <br /> Sampler m ui w V ,°°N.., "' 4 48hf 0 <br /> Moore Petroleum Signature: G�� <br /> BJ m mm Cd _ W <br /> Project Address: Sampling 'Container Preservative Matrix P m r N ~ <br /> a n m Q J o N 72hr ` <br /> B2nta,CA Qm [7 o w o Q to <br /> Sample ° a s a m a O c c c c y o N 1wk <br /> } 113 uJ CLJ J 0 ?C cis i.7 T CU <br /> T v W m r- O <br /> Desi nation Date Time oLU c3 U ¢ t7 a a a o o O m a m 2wk <br /> �t cn 0. a H Z 2 Z cn to m i— t— ,� ti. h J w 7 O <br /> A-s!3 -EFF �� �, f' X XX X 1 wk <br /> A- -lNF r rU X X X <br /> X 1 wk 62- <br /> ----------- <br /> Relinquished <br /> ZRelinquished by: Date Time Received by. Remarks: <br /> Is <br /> d byf;e1Hnqhe : D'at eTime Received by: <br /> Relinquished by; Date Time 17ecee d bALao tory- Bili to: <br /> dj�i�loy till �yl�frcgL <br />