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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 LLC Fax: 530.297.4808 714-895-5494 COC No. 78203 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 /> 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): O <br /> 211602258.400.401 78203 inbox@kiffanalytical.com O <br /> O <br /> Project Name: Container/Preservative Matrix w t» <br /> Parcel#2A-3Q11 Monitoring and Sampling <br /> Project Address: Sampling o m <br /> Z O O <br /> U. <br /> Sample E >° <br /> Designation Date Time <br /> MW-20 07/21/11 11:00 2 X X X /J' <br /> R ' uis Date Time Received by: Remarks: Special pricing of$185/sample. <br /> 072241 t <br /> Relinquished by: Date Time Received by: <br /> Relinquished by: at Time Received by Laboratory: Bill to: <br /> I I� �_ Accounts Payable <br /> contents M <br />