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Kl FF�� 2795 2nd Street Suite 300 <br /> Davis,CA 95616 r+ r <br /> Analytical LLc Lab: 530.297.4800 SRG#I Lab No. b Page 1 of 1 <br /> Fax: 530.297.4802 <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑Yes ❑No Chain-of-Custody Record and Analysis Request <br /> R. Smith <br /> Company/Address: Sampling Company Log Code: Analysis Request TAT <br /> Horizon Environmental Inc. HEIE g ❑ <br /> Phone#: Fax#: Global ID: uri <br /> 12 hr <br /> 916 939-2170 916 939-2172 T0607700482 c <br /> Project#: P.O.#: ED peliv r To(Email Address): m ❑ O <br /> 1474.03 tWQ,- 205703 `�� horizonenvironmental.net m 24 hr d <br /> O N <br /> Project Name: DV-. Sa ler Sign a n m m m <br /> Frmr Beacon 12474 BAS- W o co too a ❑ J <br /> Project Address: Samplin Container Preservative Matrix a c 0 o m N W 48hr u- <br /> 0 ¢ ¢ o 00 !` <br /> a <br /> 3440 East Main Street 0 W m 0 W w � Q a <br /> Stockton CO CD Go d o 0 a a ❑ <br /> a s < W m W L J m 72 hr <br /> a a 1 <br /> W W W i0 001 N Q , J <br /> O d O 01 U Z O O F- F 1.- R O O N U O <br /> Sample Designation Date Time a � a (9 H z z z rn ¢ m t— 1 wk <br /> A2106 � ?L'� X x x al <br /> 2 a '6 03 C�G� 1( K 02 <br /> elinquished by: Date // Time Received by Remarks: Standard TAT <br /> R linquished by: Date Time Received by: <br /> viii to: Ultramar, Roger Levin <br /> co Relinquished by: Date Time Received by Laboratory: For Lab Use Only: Sample Receipt <br /> r�,y1-?cat <br /> ! �I `��y (�� a / Temp°C Initials Date Time Therm.IDX Coag n Present <br /> p r L L A L,y of Yes 1 No <br /> 00 Distribution: White-Lab:Pink-Originator <br /> Rev: 051805 <br />