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2795 Second Street, Suite 300 Calscience l - <br /> KIFF Davis, CA 95618 7440 Lincoln Way <br /> Lab: 530.297.4800 Garden Grove, CA 92841-1427 <br /> AnalytlCal LLC Fax: 530.297.4808 714-895-5494 COC No. 78203 Page 1 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 /> Kiff 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): <br /> 211602258.400.401 78203 inbox kiffanal tical.com Co <br /> Project Name: Container/Preservative Matrix w to O <br /> Parcel#2A-3Q11 Monitoring and Sampling .61p <br /> Project Address: Sampling o 4 � <br /> z o` o` <br /> U. <br /> Sample E <br /> Designation <br /> Date Time <br /> MW-9 07/21/11 14:30 2 X X X <br /> MW-55 07/21/11 15:45 2 X X X 2 <br /> MW-29 07/21/11 12:15 2 X X X <br /> MW-30 07/21/11 12:55 2 X X X <br /> MW-65 07/21/11 16:00 2 X X X <br /> MW-21 07/21/11 11:15 2 X X X 6 <br /> MW-22 07/21/11 11:30 2 X X X <br /> MW-24 07/21/11 11:45 2 X X X <br /> LLLL <br /> MW-23 07/21/11 12:00 2 X X X <br /> MW-16 07/21/11 13:50 2 0— X X X /V <br /> Ron ish d Date Time Received by: RRemarks: Special pricing of$185/sample. <br /> ( ����� �� 7ZZ1� &D <br /> elinquished by: Date Time Received by: <br /> r� <br /> Relinquished by: ate Time Received by Laboratory: Bill to: <br /> Abp Accounts Payable <br /> Ret,., .o contents m <br />