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2795 Second Street, Suite 300 Calscience i32 <br /> KIFFODavis, CA 95618 7440 Lincoln Way <br /> Lab: 530.297.4800 Garden Grove, CA 92841-1427 <br /> Analytical LLC Fax: 530.297.4808 714-895-5494 COC No. 78189 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 78189 inbox@Kffangl)ttcal.com Co 'E <br /> O <br /> Project Name: Container/Preservative Matrix wCIO <br /> Parcel#2A-3Q11 Monitoring and Sampling p <br /> Project Address: Sampling o m J <br /> z O `o <br /> a� <br /> LL <br /> Sample E <br /> Designation Date Time 2 °' <br /> MW-64 07/20/11 11:20 2 X X I X <br /> MW-59 07/20/11 09:28 2 X X X t Z <br /> MW-70 07/20/11 08:43 2 X X X 1 �7 <br /> MW-71 07/20/11 10:35 2 1 X Ix- X 19 <br /> -A A I —r± I I I I I I I I I I I F I I I I <br /> R 'n ish d Date Time Received by: Remarks: Special pricing of$185/Sample <br /> �na i 47 -ott oc) <br /> linquished by: Date Time Received by: <br /> Relinquished by: Dat Time Received by Labor o Bill to: <br /> 2 Accounts Payable <br /> Return to contents m <br />