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720 Olive Drive, Suite D <br /> JT7C4L <br /> paves, CA 95616 <br /> Lab 530 297 4800 <br /> LLC Fax 530 297 4803 Lab No i 2 -7-2 v Page of <br /> Project Manager Phone No 916 --93Z1170Chain-of-Custody Record and Analysis Request <br /> Company/AgAress FAX No f- For Lab <br /> Ar, T �� 1�� .r -2i �Z.___ Analysts Request use only <br /> Probe umber / <br /> PO Na P[ro/ect Name / N N war(x) ` e <br /> 70 �~ N <br /> Project Location Sa pler r ature N 6 toTlu lx1 <br /> z S� Pi i2f c �Fl Co om m 3 <br /> W �n co ca m <br /> ' <br /> Cofifaine Method m 2 = i o (o a <br /> '` <br /> Sampling (Type/Amount) Preserved Matnx N 2 o a a 2 <br /> U) <br /> _J .. °D <br /> U) o 0 o a'ni m a"�i a-yi LV N <br /> O ui rn (� Q: 00 <br /> — = M 61 41 03 0} N N � N <br /> Sample E o z � _ _ a a D <br /> o ma _ U z W 0 Q i- sL 0 0 0 0 0. 4 y <br /> Designation Date Time a x z v z � m m F 0 w u� ., <br /> 7=/-,A./ I x X <br /> X <br /> y <br /> T— 1 -31 K 5- <br /> .�aa 1� <br /> _ Z_3 Y, - Uc <br /> S vel ►�' X AS X - ti <br /> R lmqu by Date Time Received by Remarks <br /> OZO <br /> elfin d Date Time Received by Email address <br /> ❑ doc ❑ xis ❑ bd ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to <br /> Distribution Whyte-Lab Yellow-File Pink-Ong+nalor COC Ih8{9198) <br />