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720 Olive Drive, Suite D <br /> Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL «c Fax 530 297 4803 Lab No 2 Page I of <br /> Project Manager Phone No <br /> Joe III M o e. (9 t6) )14-3 t 5 0 Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No 1, <br /> RK IA4 a e E o+v l r c y M iea rti (9(6) 3 5 4- 17 91 Analysis Request r <br /> Project Number P O No Email Address m <br /> 0 <br /> ❑ pdf F1 As ❑ doc ❑otherL <br /> to w co <br /> Project Name Sampler Signature m o n ?+ <br /> ^� Q3 Xd N X <br /> J• �1 .1t<< W1�{ E.k�1�cI1C L2►"ttt�Y� EN m w 4E 1.- <br /> LLI O <br /> Project Location o c m m m •a w o r H <br /> Ho'Jl►t WAy Cek,ttits L,taC st4ritto+t G 5 <br /> z = 04 o o N ~ R <br /> SamplingContainer Preservative Matrix a F U, N <br /> ON S (� y C C C C O N i6 <br /> Sample ' L w X �, m m v <br /> LLJ o Z M <br /> Date Time 0V U-J) <br /> z m NDesignation w <br /> CPT Z ' 41 JII6Ia2 goo 3 X X X X X X <br /> cp r2 --iq 935 3 x X X X .02 <br /> GpT2� 141 1005 X x x x x X -03 <br /> c rz- 151 JOIS 3 <br /> Relinquished by Date Time Received by Remarks <br /> Relinq fished by date Time Received by <br /> Relinquished by rM- Date Time Received by Laboratory /fir!'` Bdllo RgwtdP �Kvllrolviehtgl <br /> 0226D,L 1751 / P0$ M, 9gI,trAG K0oktw, CA SSM <br /> Distabutrori White-Lab Yellow-Frle Pink-Ongrnator Formslcoc 062801 th9 <br />