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KI FF 2795 Second Street, Suite 300 a science <br /> Davis, CA 95618 7440 Lincoln Way 11-10-1147 <br /> Lab: 530.297.4800 Garden Grove, CA 92841-1427 <br /> Analytical LL Fax: 530.297.4808 714-895-5494 COC No. 79088 Pae 1 of 1 <br /> Project Contact(Hardcopy or PDF to): EDF Report? YES Chain-of-Custody Record and Analysis Request <br /> Scott Forbes <br /> Company/Address: Recommantled but not mandatory to complete this seceon: <br /> Kiff Analytical <br /> Sampling Company Log Coda: ,JDSG Analysis Request TAT <br /> Phone No.: FAX No.: Global to: SLT5S0113056 <br /> 530-297-4800 530-297-4808 <br /> Project Number: P.O. No.: Deliverables to(Email Address): >, <br /> 79088 inbox kiffanal tical.com p <br /> Project Name: Container I Preservative > <br /> Matrix <br /> V <br /> Cal Farm Supply a , <br /> Project Address: Sam Ilng o @ <br /> Z t0 <br /> Sample <br /> Designation Date Time ` <br /> MW-3 10/13/11 14:20 2 X X I I I I I I I I I I X <br /> Re ish b . C I Date Time Received by: Remarks: <br /> I 1 4fr 1 CQ oo <br /> elinquis etl y: Date Ime Received by: <br /> Relinquished by: Datei Time Received by Laboratory: Bill to: Accounts Payable <br /> i°r-I I I>4a '-z - r�L— <br />