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mob= <br /> l♦ _ <br /> 720 Olive Drive, Suite D <br /> Jcj� <br /> Davis,CA 95616 <br /> Lab 530 297 4800YTICAL ccc Fax 530 297 4803 Lab No 10 1 rJ Page i of f <br /> Project Manager Phone No <br /> -u-Y,. 9 5-2.4 3 Z Zj Chain-of-Custody Record and Analysis Request <br /> Company/Address �S FAX No N For Lab <br /> 1,44 C-4 9 SLG /7ff Analysis Request use only <br /> Project Number P O No Email Address c x <br /> W m o <br /> ❑ pdf El As ❑ doc ❑other i6 a o n w v v a <br /> Project Name/Location N N `� <br /> 1 Sampler Sig atur �_ m 3 X coto <br /> w LJ m X Y C m N PI n <br /> C-M M m Q 2 5 <br /> Container Method w o w o w ° r ° ° <br /> m 0° m 0 0 " to Q N E E E E E <br /> Sampling (Type/Amount) Preserved Matnx r- co g r r = g cV U _ r~ a a n a <br /> 0 IDeo 0 in <br /> 0 LL <br /> W a ❑ m c c c N O z N t m m a o <br /> Sample W n W W xx Xt N w m 6t p1 y (A N y y N <br /> E W 0 W Z F- W W Z 2 = �c' x 'C7 m n n u u a <br /> Designation U Z (, 0 Q f F d d >L fl 0 y d O y N N v N <br /> g Date Time v cn r z _ z m m � 0 ,, Ln r• a w 3 N <br /> I <br /> -3 _ a 3 <br /> R in uish Date Time Received by Remarks <br /> Relinquished by —Time— <br /> Relinquished <br /> lm _Rer�wed btL __ <br /> Relinquished by Date Time Received by Laboratory F Bill to <br /> Aetl_� <br /> i <br /> Distribution White-Lab Yellow-File,Pink-Onginator COC fh8(5/00) <br />