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2795 Second Street, Suite 300 a science <br /> KIFFDavis,CA 95818 7440 Lincoln Way <br /> OLab: 530.297.4800 Garden Grove, CA 92841-1427 d�3 <br /> Analyticai LLC Fax: 530.297.4808 714-895-5494 COC No. 71 Pae 1 of 1 <br /> Project Contact(Hardcopy or PDF to): EDF Report? NO Chain-of-Custody Record and Analysis Request <br /> Troy Tur en <br /> Company/Address: Recommended but not"&'ciestwy to`ompiete this section: TAT <br /> Kiff Analytical Sampling Company Log Code: Analysis Request <br /> Phone No.: FAX No.: Global ID: <br /> 530-297-4800 530-297-4808 <br /> Project Number: P.O.No.: Deliverables to(Email Address): <br /> a <br /> 01-14 73710 i i 1 'ca W N <br /> Project Name: Container 1 Preservative Matrix <br /> tt3 � <br /> Celifomia Islamic Center,Lodi o p f� <br /> Project Address: Sam Iing q @z O <br /> E c U. <br /> Sample g ° <br /> Designation d <br /> g Date Time � <br /> CIC-01,02,03,04 07/12/10 07:30 3 X I I. X X <br /> CIC-05,06,07 07/12/10 07:35 3 X X X <br /> R ish Date Time Received by: Remarks: <br /> r <br /> AAR COj 717-11) lg0 <br /> Refinquishmby Date Time Received by: <br /> Relinquished by. D te T-une Relived Lab ratory: Bill to: Accounts Payable <br />