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Corporate Laboratory <br /> 208 Mason Street,Ukiah,CA 95482 Central Valley Laboratory Work Order <br /> 707-468.0401 F)707-468.5267 9090 Unioin Park Wy,,8113,Elk Grove,CA 95624 <br /> s (� <br /> clientservices@alpha-labs.corrr 916-686-5190 F)916-686-5192 Chain of Custody Record - <br /> Ali)N, Au.lyr,cal L.itwrntrniE•:Irlt '/ <br /> www.alpha-labs.com Bay Area Laboratory <br /> arATERS,SEDIMENTS,SOLIDS 6398 Dougherty Road,1035,Dublin.CA 94568 7 2 <br /> 925-828-6'226 F)925-828-6309 Lab No L j J U� U Page_of___ <br /> Company/Name: Project ID: Signature below authorizes work under terms stated on reverse side <br /> Hussein Ahmed Water Quality <br /> Analysis Request Sample Notes TAT <br /> Mailing Address: Project No: G� <br /> 7300 W Delta Ave Tracy,CA <br /> 24 hr <br /> Project Contact 6 Email(Hardcopy or PDF to): O <br /> CD 48 hr <br /> Ahmed Hussein PO# E� � <br /> ahmed_hussein_1@hotmaiLcom � Ir`' <br /> PhonelFax: Site Contact: / Lab <br /> 650-676-9687 / !, a Rom~ <br /> Q- 1 wk « <br /> Field Sampler-Print Name a Sign ur Container Preservative Matrix w `r C <br /> Sample <br /> + ti[ Collection f 2 wk <br /> d E <br /> SamP IQ E � m O 0 v c y E istandard) <br /> ar <br /> Identification Date Time a c� n _ ? s o z° o = <br /> Well Water1b��� 12 Z z 1 1 Ix x x <br /> Relinquished by Received by DateTim <br /> J^� CDPH Write On EDT Report? Yes O No <br /> � / <br /> Relinquished by ` Received by Cate Time State System Number: <br /> ;/4(l <br /> Relinquished by: Received by. Dale Time <br /> 4y �o- -�7 CA Geotracker EDS Report Yes O No <br /> Relinquished by. Received by: Date Time Sampling Company Log Code: <br /> Global ID: EDF io(Erma Addraaa): <br /> Relinquished by Received by Date Time Travel and Site Time: Mileage: Misc.Supplies: <br />