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L.i <br />720 Olive Drive, Suite D <br />FFDavis, CA 95616 m / <br />Lab: 530.297.4800 V j 2 <br />JVAINALYTICAL LLC Fax: 530.297.4803 Lab No. + 4 �� Page of <br />Proiec Manager: �� <br />V 'e� ►� <br />Phone No.: <br />;�� _ ) _ z� �� <br />Chain -of -Custody Record and Analysis Request <br />Co pany/Add ess: <br />141, //S <br />FAX No.: <br />— Z I 7 2 --Analysis <br />Request <br />t-- <br />� <br />For Lab <br />use Only <br />Project N ber: <br />'703 ll <br />P.O. No.: <br />Project Name: <br />�`j,`00 <br />� <br />m <br />N <br />W <br />w <br />C7 <br />m <br />E <br />5) <br />to <br />tl <br />F- <br />o <br />00 <br />o <br />$ <br />to <br />t— <br />C14 <br />m <br />= <br />a. <br />ayi <br />N <br />O <br />0 <br />CIJ <br />X <br />�lJ <br />m <br />x <br />a <br />m <br />W <br />O <br />O <br />CM <br />m <br />d <br />T <br />O <br />J <br />N <br />N <br />N <br />rn <br />O <br />O <br />co <br />w <br />O <br />CA <br />°o <br />a <br />W.E.T. (X) <br />' <br />r <br />\ <br />i <br />L <br />L <br />N <br />1 <br />TOTAL (X) <br />Project Location: <br />Z2 $ <br />Sam er Signature: <br />N <br />Z <br />0 <br />N <br />a <br />0. <br />U <br />U <br />S> <br />Sample <br />Designation <br />Sampling <br />Containet�' <br />(Type/Amount) <br />Method <br />Preserved <br />Matrix <br />Date <br />Time <br />O <br />E <br />.4 <br />WN <br />W� <br />W <br />V1 <br />O <br />o <br />U <br />_ <br />co <br />Z <br />_ <br />W <br />W <br />O <br />z <br />W <br />Q <br />r- <br />Z: <br />X <br />S <br />X <br />a <br />- c, <br />FFA <br />Re' uis by: <br />:�4� <br />Dat <br />Time <br />Received b Y� <br />Remarks: <br />Relinq ish�d"by: <br />___------------ <br />Date <br />Time <br />Received by: <br />Email address: <br />❑.doc ❑.xis El.txt Elother <br />Relinquished by:Date <br />Time <br />Received by Laboratory: <br />Bill to: <br />Distribution: White - Lab, Yellow - File, Pink - Originator <br />A <br />