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720 Olive Drive, Suite D <br /> VJ�� <br /> Davis, CA 95616 <br /> Lab: 530.297.4800 <br /> YT/CAL i-cc Fax:530.297.4803 Lab No. I � Page / of <br /> Project Manager: Phone No.: Chain-of-Custody Record and Analysis Request <br /> ��+� R� +tai Lgtt�) 3� i - a�3� Y Y Q <br /> Company/Address: FAX No.: I— For Lab <br /> I�c\r►e <br /> (Se_Afck✓\,ccJ C9)(,)5-) ' - ( 9 Analysis Request Use Only <br /> Project Number: P.O. No.: Project Name: �, W.E.T.(X) Y <br /> Set- to3 McAr4k-so t�r��� � N <br /> X X TOTAL(X) <br /> Project Location: Sampler na r om m 3 <br /> ZSa- 020 - 3(o 00 <br /> Container Method g o � 0 0 0co <br /> 0 � <br /> Sampling (Type/Amount) Preserved Matrix — a = N N N Z L <br /> o co co 0; co <br /> l0 M C <br /> U) 0 ' o (D Y m m N rJ — <br /> O <br /> W U' � Q. t] N N C) N (D r- -t n' 'T <br /> Sample w E z o a a Q ¢ 0 t <br /> o w a 0 0 0 0 a. M <br /> Designation Date Time v u) � m = U z m m t- Ln fl- Ln r- w w _J 0 <br /> X— - -- -0Z- <br /> Relinquished by_: f ate Time Received by: Re s: <br /> Relinquished by: Date Time Received by: Email address: <br /> ❑.doc ❑.xls ❑.txt ❑other <br /> Relinquished by: Datil Time Received by Laboratory: Bill to: <br /> 11432 "✓�� /�<< <br /> Distribution White-Lab, Yellow-File, Pink-Originator COC fh8(9/98) <br />