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720 Olive Drive,Suite D <br /> '(!AFF <br /> Davis,CA 95616 <br /> Lab 530 297 4800 NALYTICAL LLC Fax 530 297 4803 Lab No G! Page of .3 <br /> Project Manager Phone No <br /> Tilt Rawta f ( stb 3S 3zS n Chain-of-Custody Record and Analysis Request � <br /> Company/Address FAX No r- For Late <br /> q m A q4 llro h wit of q .916} 3 S i — IT 9 b Analysis Request use only <br /> Project Num erP:1 O No Project Name ,r, o o w E T (x) <br /> CD W <br /> N C14 <br /> -� Ag Mohkeca. � # <br /> Project Location Sampler Signature o TOTAL(x) <br /> 391 S Moffqt motle0v .. <br /> w 00 i$ <br /> Con ainer Methoa m 2 x x <br /> Sampling (Type/Amouni) Preserved Matrix y o n. n. v V z <br /> O t�r� U) IUD <br /> m ° 0 m a m m 1- <br /> Sample E Uj 0 QQ o Z _ a a U <br /> Designation Date Time v u� s z U z m F- w ° ° w w U C4 <br /> 513 3 -3 5 V11*9 1zo5 Is X x I 1XI—/ 1 <br /> ! S1337 (rW lztsIf x W X X JX I - 17- <br /> S84 — <br /> - <br /> Sa4 — S X x X 3 <br /> 513 - 20 t3 5 I X S X X X <br /> s R 4 5 1400 1 X s X X X — /5 <br /> t 5134 - 30 1415 I % 5 X X 'Al <br /> SB - IJ3 Isbo r X S X I X X <br /> f% <br /> SO 4 - &W Isis 4 X w <br /> 5mS -- 15 1 1550 1 XI IS X X l 9 <br /> SB 5 - ZO 1605 r X S X 'X x Zv <br /> Relinquished by Date Time Received by -q)y Remarks <br /> f <br /> 1 Doa <br /> Relln fished by Date Time Received by Email address <br /> ❑ doc ❑ xls ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to <br /> �q��1e ir'arirohw�tKtK� <br /> Disinbufron White-Lab,YeNow-File,Pink-Odgmator COC fhe(9198) <br />