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720 Olive Drive,Suite D <br /> Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL LLC Fax 530 297 4843 Lab No Page of <br /> Project Manager Phone No <br /> B. th 4anre f 6at-7zs-0 07 Chain-of-Custody Record and Analysis Request <br /> Company/Address Phy, A 9- 8' of FAX No � ForLab <br /> 8i4-% 7.02E Earll #41102-72T-107-091AnalysisRequest use only <br /> Project Number PO No Protect Name o^ o WET (x) <br /> m m 3 <br /> .� i l N <br /> Project Location a-144,,t 0 �I S-0 Sampler Signature N <br /> TOTAL x <br /> p� <br /> 2 t 1� w4`lsa� wn 5-f�K�n GR .�7.e;e o �P <br /> w U, Q is <br /> Container Method o g o o <br /> Sampling (Type/Amount) Preserved Matrix N 6 a N m m z t <br /> co <br /> N N 7 <br /> D -] N O x C C C <br /> Sample o �, Z z � Q Qto <br /> � L <br /> Designation Date Time i Ln7 z m m Ln r- N o w w 6 04 <br /> 1.51 1 1 1 �c posy <br /> Relinquished by Date Time Received by Remarks <br /> 1/2-0/M T. <br /> Relinquished by Date Time Received by Email address <br /> ❑ doc ❑ xis ❑ txt ❑other 1 <br /> Relinquished by D ate Time Received by Laboratory Bill to <br /> Distribution White-Lab Yellow-File Pink-Onginator COC fh8(9198) <br />