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720 Olive Drive, Suite D <br /> .�� Davis, CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL ccc Fax:530.297.4803 Lab No. Pageof <br /> Project Manager: Phone No.: <br /> 6 _932- 21-70 Chain-of-Custody Record and Analysis Request <br /> Company/Address: FAX Na_: <br /> F For Lab <br /> 9/63 - 7 - Analysis Request4ri �so only <br /> Proiect Number: P.O.No.: Email Address: <br /> (� <br /> '7 &S6�na�turo!.xJs . ❑ her a� W a w <br /> Project Name/Location: <br /> u1 m }C X x C 5 <br /> W U] C ar <br /> 'S c <br /> Container Method w $ w X I �, mp d _ LU ° a o a s <br /> Q a 8 E E E E E E <br /> Sampling (Type/Amount) Preserved Matrix $ _ = g " 0 <br /> s a d d <br /> o q N n h <br /> Sample N <br /> a <br /> 3 • <br /> Dei o "' o 4 a N � a � � <br /> W <br /> Designation Date Time Ow U-4) = i U °z 3 m ° ° Ui > n N <br /> Afldl- /Z q4-01103d3l <br /> Z x X <br /> I � <br /> - 3%S <br /> /1410 _ <br /> - S - I PTT <br /> gyp — IS <br /> M _17i <br /> E <br /> i <br /> i <br /> Relkquhsd by: Date Time Received by: Remarks: <br /> -117L.ilzsl <br /> Relinquished by: Date Time Received by: <br />� 907o S <br /> Relinquished by: Date Time Received by Laboratory: gill to: A# O e <br /> �M 'd <br /> Dts&ibutiair: AWte-Lab, Yerbw-F#a,An k-onpnator C (5m) <br />