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I <br /> *�A <br /> 2795 2nd Street Suite 300 <br /> Davis,CA 95616 <br /> Lab:530.297.4800 Lab No.S� a,.$q Page 1 ofNALYT/CAL ctC Fax: 530.297.4398 —�� T— <br /> Project Contact(Hardcopy or PDF To): California EDF Report? pyres p No Chair)-of-Custody Record and Analysis Request <br /> Rich Johnson <br /> Company/Address: ecommendedbut not Mandatory tocomplete this section: Arlal]/SIS Request Q <br /> Apex Envirotech,Inc- Sampling Company log Code: I- <br /> ! 11244 Pyrites Wy.,Gold River,CA 95670 <br /> �, $ 12hr <br /> Phone o.: Fax o.: o a D: � � � (� <br /> 916-851-0174 916-851-0177 T0607700183 Rhr <br /> Project Number: P.O.No.: EDF Deliverable To(Email Address): m m o $ c <br /> ERA02.004 ahnson a exenvirotech.com N _ $ $ r4 LU O <br /> Project Name: SamplerCo `L a a Qhr b <br /> Moore Petroleum Signature: m o Co o m a m o <br /> Project Address: Sam lin Contalner Preservative Matrix Co o X = w � N lahr 3 <br /> M <br /> O ti <br /> /p t7 h W N N v <br /> 5491 F Street,Banta,CA p cc �. a Ix s p � o N 1 Wk <br /> Sample FPT E Mm o o z tw- o - j O <br /> cy O to U O Q 0 ►- a a a 0 0 0 Q ¢ m m 2Wk <br /> Designation Name Date Time v rn a m z �? z cn a m m �- v, ti w O <br /> VGACEFF VEFF -S(-eS X X X X <br /> 1 wk p <br /> VGACMID I�.D� 21 X X X X 1 wk O <br /> VEWMAN VINF l� 1'b� Lt{ X X X X 1 wk a, <br /> FF- <br /> Rell i e by: Date Tlme Received by: Remarks: <br /> q-o S--3Q <br /> -96101 <br /> el' fished by: Date Time Received by: <br /> 'tS N <br /> Relinquished by: Date Time Received y l aborata Sill to: <br /> LLL <br />