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2795 Second Street, Suite 300 Calscience <br /> KIFF Davis, CA 95618 7440 Lincoln Way <br /> Lab: 530.297.4800 Garden Grove, CA 92841-1427 <br /> Analytical LLe Fax: 530.297.4808 714-895-5494 COC No. 78182 Page 2 of 2 <br /> Project Contact(Hardcopy or PDF to): EDF Report? YES Chain-of-Custody Record and Analysis Request <br /> Jennifer Worsley <br /> Company/Address: Recommended but not mandatory to complete this section: <br /> Klff Analytical Sampling Company Log Code: SIRC Analysis Request TAT <br /> Phone No.: FAX No.: Global ID: SL0002050099 <br /> 530-297-4800 530-297-4808 <br /> Project Number: P.O. No.: Deliverables to(Email Address): o <br /> 211602258.400.401 78182 inbox kiffanal tical.com 0 <br /> Project Name: Container/Preservative Matrix W O <br /> Parcel#2A-3Q11 Monitoring and Sampling p <br /> Project Address: Sampling o m 4 � <br /> z o `o <br /> aU- <br /> Sample E <br /> Desi nation 4) <br /> g Date Time n <br /> MW-35 07/19/11 07:55 2 X X X i <br /> MW-57 07/19/11 12:35 2 X X X t 2- <br /> 2A-MW-12 <br /> 2A-MW-12 07/19/11 13:40 2 X X X (3 <br /> MW-61 07/19/11 08:45 2 X X X 1 <br /> MW-56 07/19/11 09:22 2 X X X <br /> MW-62 07/19/11 11:58 2 X Xlit MW-63 07/19/11 14:30 2 X X XMW-68 07/19/11 10:25 2 X X XMW-69 07/19/11 13:42 2 X X X <br /> AelinqauCshed <br /> yhd Date Time Received by: Remarks: Special pricing of$185/Sample. <br /> ��Ft�a CQ) 072-Oil 19ot7 <br /> by: Date Time Received by: <br /> Relinquished by: atTime I Received by Laboratory: Bill to: <br /> Accounts Payable <br /> Ret-.-n to Concer, <br />