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2795 2nd Street,Su <br /> 18 <br /> KItFF Davis, <br /> b s 530 297 4800 to 300 SRG#!Lab No. Page U of <br /> LLC '%LWF / <br /> Fax: 530.297.4802 — — <br /> Send Rort T Electr nit Data Deliverable(EDD): <br /> 14� �'y'' CA EDF ❑ CA WriteOn ❑ WA EIM Chain-of-Custody Record and Analysis Request <br /> Email Address: H 82608 15241 Metals SPECIAL or <br /> C n �/ /Gl�'x'c E] Excel E] EQuIS ❑ Other <br /> lap fo�ik.c�'N (rom.etl e <br /> s Global ID(for CA EDF use): m - <br /> Phone Number: }� F x/Numbe(r�: EDD liverable (Email dre ): ❑ '6 E <br /> �• M q N < O <br /> roject#: P.O.#: Sampling Co <br /> .2 0toW v O <br /> o o <br /> n o E 2 W o <br /> W{ t > <br /> .S m Z m m <br /> f� .2� (e07 •m`m� mmm'Pro Name: Invoice 0* w-mm <br /> v <br /> wa <br /> Jli <br /> IpzChip wOw ❑W E <br /> Matrix ° FProject Address: Sampling #of Cotainers #P served ❑o <br /> Fie, - m z <br /> -6 c E E <br /> IIIM. O O n m1I mTm a m O z zSample Identification o — z o m O� � 2D te, Time e ti U 2 2 z W 0 <br /> > � 5 ❑ ❑ U <br /> IA-1 ' '110hofstI <br /> RVA ZZ F 0 no 1 p <br /> um-1 - ZLI 3 i0l0 I <br /> 3 oZv <br /> 3+- <br /> - <br /> - 3T, I 3 lloXXX X <br /> 22 <br /> ►tet- I - I I� Izl <br /> Relinquishe (si lure/affiliation): Date&Time Received by(signature/affiliation): Date 8 Time Remarks and Special Instructions(comp site,filter,MS/MSD,returnmoles,Silica Gel,etc.): <br /> Re(J)quis y(signal re/affiliation): Date&Time Received by(signature/affiliation): Date&Time _ <br /> to <br /> m <br /> W <br /> R Onquished by(signature/affiliation): Date 8 Time Received by KiH Analytical(signature): Date&Time Tu around Time(TAT-Check One): <br /> Standard❑ 4 Day❑ 3 Da}❑ 2 Day❑ 1 Day❑ Other: <br /> N 1?i T in business days. Surcharge may apply. TAT for subcontracted work may vary. <br /> o5mowor,: ongmal-lab;copy-originator <br /> Rev: 062113 <br />