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.A 1046 Olive Drive, Suite 2 Phone#:916-753-9500 N-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Western Environmental Davis,CA 95616 Fax#: 916-753-6091 <br /> Science&Technology Sample Receiving#: 916-757-0920 <br /> Pr-of-e-ctt Manager: / Phone#: ANALYSIS REQUEST Q For <br /> J�Ld /� ' to�.r \\ ►- <br /> O Lab <br /> Use <br /> Company/Address;NO/ ��� FAX#q1 54r c r( ��/ ; W.E.T.(,4 y ONLY <br /> 0 rO AL 14�y Go <br /> $ N <br /> Project Number: FrO.#: Project <br /> Name-0 Y <br /> �7.0� 33=-G l_7 Z So e �5 S c c a <br /> Project Location: Sampler atur w <br /> N D <br /> d u? o E <br /> y o� ^ - o Cn ZZ <br /> `— o ado- U N Z <br /> Sampling Container Method N c; o a o N z <br /> P 9 Matrix o � � - � � � o <br /> (Type/Amount) Preserved N <br /> Sample ID �-- � N <br /> w w fO a a a o 0 o N N t�0 a <br /> N w w J X m M w w co cD co 0 <br /> DATE TIME Qw g g Uz w0 Q ww = = QQQaaQ t <br /> O w d > 0 F- � aaaaaaaaw — c <br /> -J J J 2 = U Z > (n m m F- F- w w w w w U J U <br /> co — <br /> t OV <br /> co- <br /> _ 3 <br /> - <br /> -- /'lL LOS <br /> S <br /> JL15 J . — L2'S" -- of <br /> _ <br /> _ / 30 � - ofd �' - <br /> uis Date Time Received by: Remarks: _ EA4 e-1- <br /> y '4- o 1— O c.,.e <br /> Relinquished by: Date Time Received by: 44eE13A",,4�rZ X Z_o <br /> Relinquished by: — Date Time Received by Laboratory: Bill To: <br />