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2795 Second Street, Suite 300 Calscience <br /> KIFFO Davis, CA 95618 7440 Lincoln Way 11-08-0622 <br /> Lab: 530.297.4800 Garden Grove, CA 92841-1427 <br /> Analytical LLC Fax: 530.297.4808 714-895-5494 COC No. 78379 Page 1 of 1 <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 Due Date <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 78379 inbox@kiffanalytical.com C <br /> 0 <br /> Project Name: Container/Preservative Matrix W y <br /> to D <br /> Parcel#2A-3Q11 Monitoring and Sampling <br /> Project Address: Sampling o° co 21 <br /> O L <br /> Z ° o <br /> U- <br /> Sample E 4i <br /> Designation Date Time J °' <br /> MW-51 08/08/11 14:56 21 1 X X X <br /> -A FT 1 11 <br /> Re' .,uis ed y: Date Time Received by: Remarks: Please provide EQuIS. SVOC special pricing <br /> ZI <br /> p8081k N 00 of$185/sample. <br /> elinquished by: Date Time Received by: <br /> v <br /> h <br /> Relinquished by: Patp Time Received by La r to Bill to: <br /> Oben Accounts Payable <br /> Return to Monter, <br />