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� • r <br /> 2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 I <br /> Jri��Vj��L LLC Fax: 530.297.4808 Lab No. 3 Page f oft � <br /> Project Contact(Hardcopy or PDF To): California EDF Report? I---I Yes I o Chain-Of-Custody Record and Analysis Request <br /> S M 1 --l-, <br /> Company/Address: Recommended btA not mandatory to complete ttussection: <br /> r Sampling Company Log Code: Analysis Request I4,,, <br /> Phone Nd.: FAX No.. Global ID: m x <br /> -2 i <br /> O O N W <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): g m °N° m o <br /> l Tj j. l 0° o u5 w w N X <br /> N O O Q 3 <br /> Project Name: Sampler Signature: "' ° y °W Co <br /> a o <br /> \\ _ ./ oas W F r <br /> t�'�C tti `'J J�o ro in z = N v <br /> Project Addres Sampling Co"Wrier Preservative Matrix N o a1D M <br /> % _ m L co J <br /> ZZ Sf�j r s ^�o.1� Q m u°' p ani aNi aNi o N �+ O <br /> o m m <br /> I O W m W W S ~ m C7 rn 0 o� 0 in m N W <br /> z F- J x X X X X <br /> Sample Designation Date Time - U') cc <br /> = = v z0 cn m m F F a o 0 0 0 w >° ) N <br /> —G1 <br /> S ® !� z - Cc 3_,-off e&416 X -t <br /> Relinquished y `� c'� Date Time Received by: Remarks: <br /> Relinqui d by: Date Time Received by: <br /> Relinquished by: Date Time R eiv b oratory- <br /> BillrI 1 to: <br /> Distribution: White-Lab, Yellow-File,Pink-Originator Forms/coc 121001.fh9 <br />