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2795 2nd Street, Suite 30D <br /> ,�� Davis, CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL ccc Fax: 530.297.4808 c�C <br /> Lab No� c9C f V � Page ( of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑ Yes No <br /> t)AV E x ter- 4 Chain-of-Custody Record and Analysis Request <br /> Company/Address: Recammendedbutnot mandato tocom letethissectlan: <br /> Sampling Company Log Code: <br /> �>�. S � /�/uG� Analysis Request a <br /> Phone No.: FAX No.: Global ID: �' <br /> OCD (a N Uj <br /> F <br /> Project Number: P.O. NO: EDF Deliverable To(Email Address): g_ oXX" N a 3 <br /> / m X ]I <br /> Project Name: 5 mpl r_Sy n #ure: w m m m a O <br /> 01 <br /> TPAC � o a- 0 N y m � (1) <br /> 03 CU <br /> Project Address: Sampling r a a o C o `o NCIJ <br /> p 9 Container Preservative Matrix _ N o , ,� N — -eca <br /> m m O F w y m 67 r LL m m J <br /> O N z N o m N �7 O N V <br /> �f G _> > m d O qn c c ami S9 N r L� <br /> E W Z tW- ; c�a m C7 m m T ca N y C v <br /> w }, w _ N <br /> J U z O Q O W z z r ' <br /> Sample Designation Date Time a fn s az U z a F F- o o 0 0 w J r <br /> 4] Cl) H F- I-- lfi I� N n J W > J N <br /> �'`' E 4-3o o L Lti� K 1C <br /> QLf <br /> Re'fic),uishd by: Date Time Received by: Remarks: <br /> .tom <br /> Relinquished by: Date Time Received by: <br /> -------------- <br /> Relinquished by: Date Time eceive by Laboratory: Bill to: <br /> oto <br /> Distribution: White-Lab, Yellow-File,Pink-Originator <br /> Formslcoc 121001.fh9 <br />