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720 Olive Drive,Suite D <br /> IFF Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL u c Fax 530 297 4803 Lab No Page I of 3 <br /> ProjectManager Phone No <br /> TO Rager is i N 3 5 - 3 Z 5 o Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No r For Lab <br /> Rai, q t Ehairnn mniq (916) 35 _ l} 8 6 Analysts Request F Use Only <br /> Protect Number PO No Protect Name o N WET (X) 3 <br /> .� 9 a+t l•f m 00 N <br /> Protect Location Sampler Signature N ( <br /> TOTAL� F � <br /> 39z S MofFqt Blvd-, hC4, UJ �, o M <br /> Container Method o 2 o o ti <br /> Sampling (Type/Amount) Preserved Matrix y g a <br /> o a <br /> \� <br /> 0 o C "' a' :: :? ! Z! N <br /> Q f13 b =00 <br /> LU <br /> Q C C C c O C N A t <br /> Sample E w °z W o FhQ-- 0 a 0 O O 0 9 9 v <br /> Designation Date Time g z z v z 3 m m �- F- to ti r` W W 3 v <br /> All S B 2 - 15 8 19 99 5 X 5 x X x -� 0 <br /> SB I - 20 goo 1 X $ X X X <br /> 5B z - 'tS RZO i x S X X1 X - D <br /> Sol 30 835 1 i 1 t x 5 X X <br /> ASa — 43 1950 I Ix S X X <br /> G-W Lo 1 5 4 X Ix I W X X X . — Q G <br /> $83 - 15 110S + x S x x X - 0-7 <br /> 3a3 -- 10 Ims I X 5 x X 0 $ <br /> i SB3 - 29 113b I X 5 X X X — 0 <br /> 5B3 - 3G 1145 I ;K S X X X — ! D <br /> Relinquished by Date Time R Wed by y��a„-F Remarks <br /> Relin uished by Date Time Received by Email address <br /> I <br /> ❑ doc ❑ xls ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to Rq h 4 f$ FhY i r d'%w N R <br /> FOB 869( Kq%ck6 *Ahtta LA 45683 <br /> Distnbution White-Lab, Yeflow-File,Pink-Onginafor COC fhb(9188) <br />