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2795 2nd Street,Suite 300 <br /> Lab: 30.297.4800 SRG#/Lab No.Davis,CA 95618 so t_ <br /> i1Cc�11.LCKU-1- Fax: 530.297.4802 Page ` of <br /> Proje tCo tact(H rdcopr or PDF o): California EDF Report? [I Yes ❑No Chain-of-Custody Record and Analysis Request <br /> q 1Gl:lt wC ERAA <br /> Compan /Address: Sampling Company Log Code: Analysis Request TAT <br /> W1 tSLS *6%,&1 tL Fir #001 Sa to IVSIS <br /> Global ID: <br /> Tho umber. CIRCLE METHOD <br /> `l16-V4-0131% X• tt g 12 hr <br /> m <br /> Fax Number: EDF Deliverahl�To(Email Address): <br /> Ib^ate+-1378 ¢ `° - ElN m >. <br /> Project#: P.O.#: Bill to: w a N a 24 hr 0 <br /> 0 A'740-OS ao <br /> w a o c � 0 <br /> Project Name: Sampler Print Name: W p W N g n -- <br /> F�, L�sco w m m .= o ti <br /> M m g o N a g m 2 0 48hr <br /> Sampler a N m 0 N ¢ v N u�i O ti <br /> ¢co a W °6 W J ¢ m ¢ N n n <br /> Project Address: Sam lin Contetrfer atrix Di o o ¢ H - a- w ¢ G o ❑ <br /> 2921 W. 11&5J--; .SF 3 .0 o � o o '�y W W W W P 72hr <br /> d t0 F N U t3 Q N N ¢ 6 <br /> • '� "'` S20 Ocv oT@ U y ' � m m o !9 m a LU a O gaAli- <br /> p <br /> v YY71ri <br /> 0 ccvEl1 (4 m m 19 <br /> kzom <br /> S = _ BW 1 w <br /> Co F n o > > >o <br /> Sample Designation Date TimeM co <br /> t°- 3 <br /> • 41y1'Z Cilia. X X X x x X x x k 01 <br /> -EkSt` 100 k K M X k X 2 <br /> 5Tt?C:k Pt t->` 10gS <br /> Relinqu' ed by: Date Time Received by: Remarks:S (L®, �p: 1 sae4tK&a eYP4. D" <br /> 2lribs 133 cSttit d0, "i tjbb �0 : $Q.vCM(?S�eel-1.c*-I <br /> eli cashed by: Date Time Received by: <br /> Qvi44 T741 + ss�6(te /t�,�vr . qu-Av 1if 4,L,v+ <br /> Relinquished by: Date Time Re 'ved rZA La rat <br /> '021111 133 dE�) �� JV'4� 0* -416, <br /> Distribution: White-Lab;Pink-Originator <br /> Rev: 060405 <br />