Laserfiche WebLink
720 Olive Drive, Suite D <br /> .�� Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL ccc Fax 530 297 4803 Lab No lacm page—5 of <br /> Project Manager t Phone <br /> h "° r 66 3 �+ry <br /> Chain-of-Custody Record and Analysis Request <br /> Co pany/Address FAX No H I For Lab <br /> c 83C — 6 W Z Analysis Request use only <br /> Project Number PO No Email Address <br /> 6Z —0 — 1 Elpdf ❑ As ❑ doc ❑other '� p m co a 9 <br /> La QO N cA 91 - p <br /> Protect Name/Location Sampler Signature ° ' °0 b <br /> N m {� N Q O - 'S <br /> Container Method u� m w m w N E a e E E <br /> Sampling (Type/Amount) Preserved Matrix 00 = $ N - ^ ca cL a aa. <br /> _ 0. N Ov J N w n in <br /> J H d <br /> O m EDV <br /> O w � 03 <br /> m ¢ o 2 0 8 m ti N s it s <br /> W W C �p (9i 9 co p a u u u u <br /> Designation Date Time i i v z 3 M r in UJ `~ N N 001 <br /> (1Z _ <br /> -43 <br /> LO -44 <br /> ICS C -/t5 <br /> f. <br /> -2 C) -*> <br /> R wished by Date Time Received by Remarks <br /> �t t o� <br /> Re inqutshed by Date Time Received by <br /> It <br /> Relinquished by Date Time Received b UIDQratory Bilk to <br /> �(L74 ZC��` AL) -YR <br /> Distribution White Lab Yellow File Pink-Originator COC fib(5100) <br />