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i <br /> 720 Olive Drive,Suite D + <br /> 4 <br /> tAjJVATLY7'1CALLLc <br /> Davis,CA 956i6 <br /> Lab:530.297.4800 Fax:530.297.4803 Lab No. 2--Z Page of 02, <br /> Project Manager,- Phone No.: <br /> wyi6 Chain-of-Custody Record and Analysis Request <br /> Co anylAddress: FAX No.: <br /> A/0 0"4 v. rvc . 9 ,�9- .1-/ 7,2, Analysis Request Ti a O yy <br /> Project Number: P.O.No.: Email Address: <br /> `f7 y m Kaaaa <br /> i ❑.xis ❑ ❑ ther � <br /> Project Name/Location: � # <br /> Ui <br /> MP r Signature: 40 " m iii <br /> to <br /> Container m m <br /> s <br /> Method xu v► : CS, <br /> Sampling (TypelAmounl) Preserved Matrix � p � °° � m y E E E E <br /> _ ri d d ai <br /> a O o <br /> a O '� u�'. <br /> Sample N § <br /> a O y o ' °fig° N 3 �3i <br /> C rl tV I� �S C d i c�3t O Q °` S t✓ N <br /> Designation C w o �, z m • • • <br /> 9 oats Time a 0) z � L) z 3 � � h � a � � � � a � � _ � I s t � <br /> " <br /> - j4Mq-6-O << 3 x x x <br /> IY y - -.3 1/'�S <br /> c _ _ o.�s <br /> - <br /> y - fir/ <br /> Ret nqui by: Date Tiime Received by: Remarks: <br /> Relinquished by: date Time Received by: <br />� 70 <br /> Rellnquished by: Date Time Received by Laborato Bill to: oTv <br /> i t�si7rihution: White-Lab,Yellow-F".lhnk-Originator COC.fAB(SIDO) <br />