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Excelchel <br /> 300 Broadway Street <br /> Eureka CA 95501 CHAF-CUSTODY RECORD AND ANALYSIS REQUEST4P <br /> Environmental Labs Ph 707-444 0120 Fx 707-444-0560 <br /> Project Manager Phone# Electronic Data Deliverables Request <br /> Joe Ramage (916)354-3250 Global I D# Email Address <br /> COC# <br /> Company/Address Fax# Location I D# <br /> Ramage Environmental (916) 354-1787 <br /> Project Location Project Name ANALYSIS REQUEST Paeof <br /> 2222 E Weber Ave , Stockton SJ County Courthouse <br /> Wet Bir <br /> �J (J <br /> Electronic Data Deliverables Request ,� � 3 V j} <br /> Global i D # T0607700470 Email Address doulosenv comcast net o o Total 6 Due Date <br /> rolecr uocaEionamp er igna ure oLO o N cli (D O> <br /> mw r� mS CD <br /> a � � N m <br /> co m W Q <br /> LO <br /> Sampling Container Method Matrix � E a a N N <br /> Preserved o m o 0000 N <br /> U) m o O m <br /> Sample c� � r M � Nm y� 2 <br /> QO <br /> ID ai ai cv m �' y u- a'�r N / <br /> Date Tune w c� m o o °s iv o - C r <br /> wco w w w m 0 0 0 ti m mcn O U Z U O Qm CL a o d U 0 0 Q) y m ¢ � o mLAB U5E <br /> z _ z cn ¢ m � F- a a � Lo rn v U aONLY <br /> r� <br /> rHl w��Z <br /> R ished by Date Time Received by Remarks/Condition of Sample <br /> Please include methed blank results, <br /> Rlblinqtshed by Date Time Received by QA/QC and surrogate acceptable linuts <br /> Relinquished by Date Time Received by Labor tory Bill To <br /> 3I of y J <br />