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720 Olive Drive,Suite D <br /> Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL Lac Fax 530 297 4803 Lab No I Page A of <br /> Project Manager P one No <br /> GA VZ� A VZK� zci 16ct q- 1-7 o Chain-of-Custody Record and Analysis Request <br /> Company/Address 1 FAX No I— For Lab <br /> 12 t`ZO Q t�E-!U v 1120 Q M E Analysis Request use only <br /> Project Number PO No Pro ect Name ; a o WET(XI <br /> -70 aq --1 49- 039 <br /> N <br /> Project Location [ Sampler ignaiure TOTAL(% <br /> o <br /> 7e o, Ve, �ck-1ovN m i + <br /> ontainer I Method <br /> Sampling (Type/Amount) Preserved Matrix g = * a ' a N z z <br /> O t <br /> v v O) <br /> C <br /> O N Z $ oa N a <br /> ESample UJ04 <br /> Designation _ = W a a <br /> M a. n-pate Time a o z in <br /> 4 tN <br /> W c� <br /> iy1 <br /> S o - MW - 3z <br /> 5-- nn w I X I I -3 3 <br /> - 50 - nn w -3y <br /> do <br /> P A -37 <br /> Ri wished byData Time Received by Remarks <br /> ie t W+V Iz3 ''iovAM C0%4�J vin w <br /> elinquished by Date Time Received by Email address <br /> ❑ doe IJ As ❑ txt ❑other <br /> Relinquished r at Time Re ed y La ratory Bill to i <br /> I(7 9011 VQ-LZo Q GLV v I V-0 N M e-AJ`T, L. <br /> Dislnbulion While-Lab Yellow-File Pink-Onginalor COC th8(0198) <br />