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720 Olive Drive,Suite D <br /> .�� Davis, 95616 <br /> Lab:530.0.297.48.48 <br /> 00 <br /> JANALYTICAL LLC Fax:530.297.4803 Lab No. _3 Page Z Of <br /> Pro}e Manager: r Pho a No.: Chain-of-Custody Record and Analysis Request <br /> �Ar �k e4_ . t4 16 439- 7-170 Y Y q <br /> mdress: FAX No.: F- For Lab <br /> or!ZCr► rFnVl f ;1^Gwlad rKc (11�)13q -Z r?Z' Analysis Request use only <br /> Projed Number. P.O.No.: Project Name: � � � W.E.T.Ix) <br /> Torre(x <br /> C�0 Gy0 ' N <br /> P%ec .Loa9 n: l � na re:wz? <br /> mm <br /> Container Methodoo <br /> _ <br /> Sampling (Type/Amount) Preserved Matrixo a C4 z r <br /> p o 3 Q Z <br /> Q rA N N S O a 40 O o N t <br /> T %w LU in 2 m m C� N N a <br /> Sample € 01 O w z Q _ � O0 a a v v N <br /> Designation Date Time g i z Z m n w w U <br /> Sso - f39 toatgq jI 190 <br /> • 5 ss - B9 � -r <br /> • by - 8q � <br /> 5 65 - 89 I <br /> . '5 .. 6q I - <br /> 57s -81 1l <br /> • 54a - <br /> 545' - em <br /> Relinq b pate Time Received by: Remarks: <br /> -'A !O —-— ----- <br /> Retlnquishad by: Date Time Received by: Email address: <br /> ❑.doc ❑.xis ❑.txt Bother-- <br /> Relinquished <br /> other_Relinquished by: Date Time Received by Laboratory: Bili to: <br /> brls/�r� l�j' C:yY <br /> Did4butba: Whife-Lab. Yekow-fRe.Ptak-Originator COC.fhe(9196) <br /> i <br />