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720 Olive Drive,Suite D <br /> IFF Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL <br /> LLC Fax 530 297 4803 Lab No Page of <br /> Project Manager Phone No <br /> ua.3' Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No t— For Lab <br /> Cii b Analysis Request use only <br /> Project Number P 0 No Email Address m X <br /> t9—O<� ❑pdf ❑ As ❑ doc ❑other u' m m w y q a q <br /> Project Name/Location Sampler Signatur 2 m m a Q x N <br /> n r <br /> —R 1 (. Nla Ot w a s <br /> N <br /> O F H CV W O M m a 5 <br /> in m O 'ti c `0 0 0 <br /> \Jcontainer Method N .. ` <br /> o H i7 o U E <br /> a E E E <br /> Sampling (Type/Amount) Preserved Matnx _ <br /> m Z = N 0 J p N w ,ll uy of <br /> J N O <br /> N = D O CQ l6 A 1p C W a <br /> O j m o m �' = v a x s <br /> Sample E tu o z a c n ., <br /> r <br /> Designation ¢ J " Z ° a 4 a ° J W -9 € N N e <br /> Date Time v v? z z _ z m m .- �, r- <br /> 1�1,W- <br /> X <br /> VI w•3 13c 3 Y\ X '—�j <br /> MW 3 x x —a`/ <br /> A; I VT <br /> Relinquished by Date Time Received by Remarks. <br /> S- !^Lt'J n- <br /> Relinquished by Date Time Received by <br /> Fmhnqutshed by Date Time Received by Laboratory Bill to <br /> Disrnbuilon White-Lab, Yellow-File,Pink-Onginalor COC fhb(5100) <br />