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®� 3050 Industrial Blvd. <br /> ®® West Sacramento,CA 95691 CLS Page L of <br /> Tel:916.372.1434 v Lab No. — <br /> wo°aoo."""" Fax:916.372.2565 <br /> Chain-of-Custody Record and Analysis Request <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑Yes No <br /> Bryan C.Yates Analysis Request ~ <br /> Company Address: Recommended but not mandatory to complete this section: Q <br /> Sampling Company Log Code: N 12Hr <br /> see above ce' Q <br /> Phone No.: Fax No.: Global ID: <br /> L 24 Hr <br /> (916)372-1434 C, o E ti O <br /> Project Number: P.O.No.: EDF Deliverable To(Email Address): <br /> b ates@wallace-kuhl.com a o 0 o <br /> 6364.07 < w o N <br /> Project Name: Sampler a w L a N 72 Hr <br /> Oak Ridge Winery-Quarterly Sampling(Q4) Signature: w o m E 5 v 0 <br /> L 2 v A <br /> Project Address: Sampling Container Preservative Matrix N N -' <br /> m o°7 a Z E m N 1 WK `p <br /> w LL <br /> m � 7L, <br /> y a mo E W g r <br /> Oak Ridge Winery,Lodi,CA Q 2WiC <br /> UJ aK Q d g a E <br /> Sample O> > J ¢ Jw O E ELIJDesi nation Date Time a _ = <br /> MW1 1y 3#1 1211* # X1 I * x I x x x x x x x x <br /> MW2 13ZY 3# 2 1* # X1 I * x x x x x x x x x <br /> MW3 )-4Z( 3# 2 1* # X1 I * x xxx x x x x x <br /> MW4 1 S3 3# 2 1* # x * x x x x x x x x x <br /> Relinquishej�d bye,�y � <br /> Date Time Received by: Remarks: <br /> fV 12 " « iSyu <br /> Relinquished by: Date Time Received by: <br /> Please email to b ates wallace-kuhl.com <br /> Date Time a ived by L boratory: Bill to: <br /> Relinquished by: �3 -" <br />