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2795 2nd Street,Suite 300 0 /- <br /> KI FF Davis,CA 95618 <br /> Anal tical!1C Lab: 530.297.4800 SRG#/Lab No. / Page 1_ of [_ <br /> y Fax: 530.297.4802 <br /> Pro'ect Coact(Hardcopy orPQF j�: California EDF Report? ❑Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Adgless: / Sampling Company Log Code: Analysis Request TAT <br /> lJ.�l'PCCQ�✓)S r�/T7n ���o/D�u <br /> CIRCLE METHOD ❑ <br /> Phone Number:/�/6 oD Global ID: <br /> 12 hr <br /> m <br /> Fax Number: �6/-G`f EDF Deliverable To(Email Address): <br /> 6 3o C) s <br /> Q N m ❑ T <br /> Project#: P.O.#: Bill to: w a N m 24 hr <br /> a' a m <br /> 1/ w a o <br /> Project Name: Sampler Print Name; = <br /> N oY o a <br /> `M o a Or2 <br /> iU w "' LLSampl'er Signature: W o <br /> 00 <br /> WWCL + aWJ O t` <br /> Co <br /> Project�AdrdarePss:�`D'ol"is& I&P/ Sampling Container PreservativMatrix Q. < U ci <br /> C'AEl on W o O 72h <br /> r <br /> a On '0 w <br /> N <br /> aLD <br /> CD 0 <br /> m p m m N o a w <br /> N V W !1I d m m i0 J r LJ <br /> E y > o O c ' - m w = K X m m m a = x ui 1 Wk <br /> o 2 o m m U Z o f° o I f a o O m o 0 o d a Q 3 m o <br /> Sample Designation Date Time v rn D_ 0 t- x z ¢ m P r- J > > > r- <br /> D!✓lr'� A n L214 /O I J I L/' v� <br /> Relinquished by: Date Time Received by: Remarks: <br /> 4- <br /> Relinquished by: Date rTimeReceived by: <br /> CC <br /> Relinquished by: Date Re b La at11i610 t r <br /> Aict <br /> Distribution: White-Lab.Pink-Originator V IF <br /> Rev: 06040E <br />