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KI FF 2795 2nd Street,Suite 300 <br /> Davis,CA 95618 G r l <br /> Ana)yrtcal LLCO Lab: 530.297.4800 SRG#1 Lab No. ` Page ` of 1 <br /> Fax: 530.297.4802 — <br /> Pro ect Co ct(Hardco y or PD Tp); California EDF Report? <br /> C {re (�, �rfPi ❑Yes 12No Chain-of-Custody Record and Analysis Request <br /> Company 1 Addre6e R-1 0,VVC <br /> // VO Sampling Company Log Code: Analysis Request TAS' <br /> r Vol< PLEASE CIRCLE <br /> Phone Number: _ Global ID: METHOD ❑ <br /> m 12 hr <br /> Fax Number: 7 EDF Deliverable To(Email Address): m <br /> {j Q w o <br /> / Q N CO <br /> Project#: P.O.#: Bill to: w a W $2 �hr <br /> CO rn R y <br /> Project Name: / / Sampler rint N e: i ui w ;� a <br /> ,ly�u &4 NYrI Se Vol r� P r te' ° m a go � � " L — ❑ cc <br /> r b <br /> `D a , 0 48hr <br /> Sampler Signature: r o m = u�i � w N wi — N - o <br /> N W �r Q N N 4 p _ On L <br /> r Co <br /> ryj Ul W N to m O Z p <br /> ad J O ❑ <br /> Project Address: Sampling Co ner reservative Matrix w � o X ¢ "c 7 w a w ¢ a <br /> U U- o o U <br /> CL CA J <br /> °' r -e t3 8 W w a 72hr <br /> p ! y N <br /> Q uai coNa w a <br /> f Q C < W > 1p 21 21 N o N w O <br /> > �, U W d = o 0 0 a ' J <br /> N ca G7 W U rn o7 <br /> E <br /> T o N° d U z o '0 m LU F a- o 0 m o 0 0 a nom. ¢ 3 m 0 ui <br /> 1 wk <br /> Sample Designation Date Time � v) a C7 x x Z v7 '¢ m > > > <br /> I I V1o� <br /> Z7 X1 X X <br /> u � <br /> 0 <br /> 3 I <br /> CrZA. <br /> a 12 <br /> 02 <br /> t: <br /> Aqu.,,' by: Date Time Received by: Remarks: <br /> jb5 -,�0P05i` c 5 _ 1 " Bf Date Time Received by: I YL- C <br /> 4( 5 <br /> 17 <br /> cc <br /> Relinquished by: Date Time Received by Laboratory: « For Lab Use nly: Sample Receipt <br /> }4 l f 1(„�� �Q 1 ;_ / Temp°C Initials Date Time I Therm.!D# Coount Present <br /> Distribution:While-Lab;Pink-Originator <br /> Rev:06170e <br />