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.�� 2795 2nd Street Suite 300 <br /> Davis,CA 85616 <br /> ANALYT/CAL ccc Fax:530.297.4808 Lab:530.297.4800 1-ab No. <br /> Page 1 of 1 <br /> Protect Contact(Hardcopy or PDF To): <br /> Rich Johnson California EDF Report? ❑Yes ,,❑No Chain-of-Custody Record and Analysis Request <br /> Company!Address: <br /> m+nd�d but not mandatory to complete this section: Analysis Request <br /> Apex Pyrites W Inc. Sampling Company Log Code: Q <br /> 11244 Pyrites W -,Gold River,CA 95870 Phone F- <br /> No.: Fax No.: Global ID: _ El916-851-0174 916-851-0177 6077 183 _ m 12hr <br /> T "' <br /> Project Number: F.O. No. EDF Deliverable To Ema ddress}: Co °° w O <br /> ERA02.004 mo o 3 24hr c <br /> ohnson irotech.com <br /> Project Name: Sampler _ .m 1:1O <br /> Moore Petroleum Signature: : < "' C A <br /> a a <br /> _ 48hr : <br /> Protect Address: w �' w w ° 0 _r ~ <br /> Sampling Contain reservative Matrix 5 " " ¢ 0 .0 <br /> 5491 a m ca <br /> a a m n 4 0 72hr <br /> F Street,Banta,CA 0¢ 1 m `� y �y Q <br /> Sample ; a o _ � U.1wk <br /> E w m w w p to (m i m a) <br /> Desi nation w <br /> J_ <br /> Date Time o -� O 2 w U z O ¢ p �" x z O O a 2wk <br /> V- rn a- Q 1— ( z U z u3 > m m d F0.- 0 0 u r r+ W w � � <br /> V-GAC-EFF -�-(}S ;�{} x7T] x x <br /> 1$1 <br /> O <br /> V-GAC-MID -L"OS r�l/� X X <br /> X <br /> x X <br /> VEWMAN �'�`�� i�i� X X X <br /> x o <br /> Baling s e LITT <br /> Date Time Received by: Remarks; <br /> Relin uishe <br /> Date Time Received b . <br /> H Rellnqulshe y Data Time Received by La oratory Bill to: <br />