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OEM NO IIIIIIIIIIIIIIIIIIN WIN I = = = = r MINE M � <br /> 2795 2nd Street,Suite 300 <br /> i <br /> bavis,CA 95616 <br /> Lab 530 297 4800NALYTICAL tic Fax 530 297 4808 Lab No g Page _ of <br /> Project Contact(Hardcopy or PDF To) California EDF Reports Z Yes ❑Na <br /> -�-- Chain-of-Custody Record and Analysis Request <br /> CompanylAddress aTlol <br /> Sampling Company Log Code Analysis Request <br /> Phone No FAX No Global lD <br /> 16J ro0 U4cm CM <br /> s- � <br /> Pro ect Number Pro No EDF Deliverable To(Email Address) LU <br /> m fl x C <br /> 0. <br /> Project~Name 5ampldr Sig attire $ ;n S w mo ''4a w o r <br /> _ _Co <br /> N V o N <br /> Project Address Sampling Container Preservative Matrix n a m <br /> 4 0 <br /> A li} o = p m c c c > Q m N t LL <br /> w m m m m 0 c� w = a a <br /> n ltl til °A or m w C N <br /> co <br /> E to O Z a a s W L <br /> -Sample Desi nation nate Time n i z U z � ° m h ° W > " <br /> 3 XY, �( 1 <br /> x x <br /> _3 �( 3 <br /> Jcl I -04 <br /> Relinquished by Dale Time Received by Remarks rnW^-i AEAM iLwTla a FK rnTbF. <br /> ehngwshed by Date Time Received by <br /> _ I�r {Z+L <br /> Rehnqulshed_by___v Date Trme Received by Laboratory KiFF 8111to <br /> rs A*YPqt_ <br /> Dislnbutron While-Lab Pink-Ongrnaior Formslwc 121001 th9 <br />