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1046 Olive Drive, Suite 2 Phone# 916-75 - 500 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Westem Environmental Davis, CA 95616 Fax# 916-753-6091 <br /> Science&Technology Sample Receiving# 916-757-0920 <br /> Project Manager Phone# ANALYSIS REQUEST ¢ For <br /> �- Lab <br /> KPA 27� Use <br /> Cpany ddr ��2 FAX# WET (,.A ONLY <br /> vPr r-,r 449 7V3 <br /> ✓ TOTAL(� <br /> Project Number P O# Project Name L N <br /> 020749 z�6 S�i o�- fsZ'44-4 <br /> Project Loca Ion Sampler a � r a r <br /> N 3 <br /> m t m c�j 7 <br /> �Y ' v p co m U ro M Z <br /> Sampling Container Method o �' z <br /> o o a o 0 0 �° C a <br /> P 9 (Type/Amount) Preserved Matrix ,� o w w � a ti C N <br /> Sample ID " � 0000NN � o " _ � N <br /> o = <br /> DATE TIME m W w -� x a <br /> 2T N 5 <br /> O LU 0 a UZ V O a0 � F- a- (La.cL ¢ � � N <br /> > N J 2 2 _ Z U} cq Q7 H W W W W W U(021 <br /> J U <br /> S' <br /> 10,/f 1 <br /> OA 2[- 3 Q% <br /> 41Lw_ 2 - D ' /, <br /> _ L tf•Q� <br /> fd <br /> w-3 a' /T 2 ZA <br /> Relinquished by Date Time Received by Remarks <br /> Relinquished by Date Time Received by <br /> R quished by Date Time Received by Laboratory Bill To <br />