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Kl FF O 2795 2nd Street,Suite 300 <br /> Davis,CA 95676 s <br /> ArwVdcal <br /> Lab: 530.297.4800 SRG#/Lab No, T_I j�7go? Page � of <br /> Lt.0 Fax: 530.297.4802 <br /> Pro'ect Con ct( rdcopy or PDF To): California EDF Report? Yes ❑No Chain-of-Custody Record and Analysis Request <br /> 1AWe Snit e> -"s . caM <br /> Company/Address: "M S Sampling Company Log Code: Analysis Request TAT <br /> C, I Rcr�d- / L! AMdo TD5 <br /> Phone N ber Global ID: ctacLe rsTroo ❑ <br /> 3,� SLrCa 5011305(, _ 12 hr <br /> Fox Number: E F Delivble To(Email Address): _ <br /> Sa W-- .tI Ae--t t. �� ,t�Cly� m ❑ <br /> Project#: P.O.#: BIII to: �e 9: r w a n $ 24 hr <br /> Project Name: Sampler Print Name: w, <br /> O m m .� O ❑ <br /> C� i �i 1 M SSI�Ym o a n 6 co 48hr `o <br /> Sampler Signature: w m w o <br /> y N 8 0 LL <br /> o <br /> Projet�t,Addr�e$Ss: Sam lin Container Preservative Matrix a o ' a a a G o ❑ <br /> W. w J J 72hr <br /> N w y <br /> 7 7 ,n m a ,. e a w. c <br /> O O O <br /> E <br /> E i m m <br /> X x w R t' L 1�wl..k <br /> v T W O <br /> Sample Designation Data Time a rn a° 3 F i = i 3 m < s m ra- „ >° >° >° I!w a 3 <br /> W'1 13 l b k X X J� <br /> MW <br /> M -3 I ✓ X o) <br /> o X X 4 <br /> nn w - oo II IJ 4 P(I o <br /> SoI I , o6 <br /> Relinquished by Date Time Received by: Remarks: <br /> ellrpueh a Time Received by: <br /> elhrqulehed by: Date Time ReceivedgLabo10h I u <br /> DhmW�: vnire.Leb:Rck.odylnakk <br /> Rev. 060409 <br />