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r T <br /> 720 Olive Drive, Suite D <br /> t <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> NALYTICAL L Lc Fax:530.297.4803 Lab No. 0 Page / of 2 <br /> Project Manager: Phone No.: <br /> pt 2� � ,Tg - y„o Chain-of-Custody Record and Analysis Request <br /> Company/Address: FAX No.: <br /> I--I For Lab <br /> 2r 7-00.4 =/v L 9/6 F 4 - 1i 7 �- Analysis Request use only <br /> roject Number: P_O.No.: Email Address: _ m x <br /> y _ 3 ❑.pdi ❑.xidoc ❑other o ppm ui D <br /> ' m 04 <br /> a 3� A c' <br /> Project Namell-ocation: Sampler Signature: yV( �X( m pmp x S <br /> m K A A h <br /> L?YRcor� oG u <br /> N <br /> m <br /> Container Method W 4i 0 Co <br /> m 0 �_ E E > F <br /> Sampling (Type/Amount) Preserved Matrix io r z z n c - c , d d d d <br /> IL CLN m J 4 N P n ail �n In <br /> ~ O a N '3 {, <br /> n a <br /> LL <br /> P a 2 0 <br /> Sample ' � in W W m a s N a t N ,r � � � a <br /> Designation Q _ 0 a Q 1 a a a o 0 0 o a o <br /> Date Time v to = r _ z m m F r r- %n n In n w > A r N 7 <br /> )< <br /> I I <br /> >< G1 Z <br /> MW- g r -3-nr I syr 3 x• >< W x -03 <br /> w _ S- <br /> Y-t'r `3;15 <br /> -oB <br /> WA K <br /> i <br /> I !✓_ /D 1-y-y1 <br /> Relinquished b ' D to Tim, Received by: Remarks: <br /> peal <br /> �� <br /> Reli uished by: Date Time Received by: <br /> 774 <br /> [Relinquished by: Dale Time Received by Laboratory: Bill to: <br /> Distribution: White-Lab, Yellow-File,Pink-Dri iinator coc Rha(SWI <br />