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.�� 27952nd Street Suite 300 <br /> Davis, <br /> CA 95618 <br /> Lab:530.297.4800 Lab Ivo. L��a�7 Page 1 of 1 <br /> ANALYT/CAL tt c Fax:530.297.4808 ._ <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑Yes Na Chain-of-Custody Record and Analysis Request <br /> Rich Johnson <br /> Company!Address: - ecommeeded but not mondnnIn complete this seep w Analysis Request I— <br /> Apex Envirotech,Inc. Sampling Company Log Code: <br /> 11244 Pyrites M.,Gnld River,CA 95670 <br /> Phone No.: Fax No.: Global ID: mEl <br /> 916-851-0174 916-851-0177 TOB 183 r 04 w 0 r <br /> Project Number: P.O.No.: EDF Deliverable T Address): - g 3 <br /> ERA02.004 r'ohn24hr �, <br /> . w <br /> C <br /> Protect Name: Sampler $ ,� Y3 H `� <br /> m <br /> Moore Petroleum Signature: ' ANw ,� $ w e, H w 48hr <br /> Project Address: Sampling C nt ' Preservative Matrix W z <br /> p , a E o � t a 72hr .3 <br /> m 016, <br /> 5491 F Street,Banta,CA Q N = m o m m m V o U! <br /> Sample Ui IL_ o Z w J o w CU C9 a a m w m O <br /> Desi nation - w U z ; o a o ¢ a a o Q 2wk <br /> Date Time to 1— _ z 0 > m m r �, � LO � J w > O <br /> �. V-GAC-EFF 2'3'45 `Q X I X I I X I X1 I <br /> Jwk C1 r <br /> V-GAC-MID 7 3-0 S N ; Q X X X X <br /> 0. <br /> VEWMAN 7-�~os' 1 :L6 X X X X 03 ' <br /> I- I I I I +H <br /> Re nq sby: Date Time Received by-. Remarks: <br /> ,5-05 I od <br /> Relinqu Y Date Time Received by. <br /> - <br /> ;y <br /> by. Date Time Received by Laboratory: �j Bill to: <br /> o�oc{GS 13io K 14 /"rr'4"-A''-I <br />