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CHAIN OF C-U TODY 1 LABORATORY ANALYSIS REQUEST FORM ] Page�L-- ,i)t- <br /> rI _ <br /> APTIM APTIM [';nvironmeie: & Infrastructure,H-C l'p Number PCARD <br /> 4005 Port Cffica go kighway,Suite 200 Concord CA 94520 Lab: <br /> .�rrn;e- of pi me- I r-vrc.Tvsicy-CA Analysis Re ueSled <br /> APTIM Project Number: 723019111 <br /> PDF Report to: Jody Rhoades m <br /> Csmai I: .1 ody.RhoadesZapthuxom as <br /> Cell Ph:530 933 S2 Ga o Q <br /> CC Report to: 0 <br /> Sampler's Signature: ,u a ,;. y <br /> REMARKS <br /> T F-5astlple I.AB sample Cantaincr 1}pes <br /> L1). Date Time LD. Malrix Preservations <br /> Q 1 � l` 1 <br /> JI a 1f <br /> EtL•'I h[.]llI F �- ' R1�: •;n 131' Hr:I..iN[lliitilllStl 61 ftl:[:1:1�'F:11 131' 'rtiR�l:lltCJl'\f) 1tr.l'C7R•r ItF:fal'rR>u:�lrk fti•rS <br /> ��"_ RI;Qttlltr•:�Itsr\'"I'S 7C I. Ruutinc Rclmit <br /> Si aaturc� Ssgr ttrrc Signature Signawre Z Sshr _•+s In —sJ. II. Report(includes r)r1P.MS <br /> 0,!1 ce,,,dud t•m-rss�.xM ,r MS 1).as required_ma}be <br /> Printed Na+ c Prints amc Printed Nan+c Printed blame r';—K1.V&W r..•NMIMY PWSMItc chargu�d as samples} <br /> Vmv,&rA\t9eLminan•RO-dn 111.l inn Validation Rcport <br /> Firm Firrn P n l irnt Requo•5xd a uhrI enc (ineludes Ail Raw Uata) <br /> All JIM0 Rw(CR <br /> Daterrin+c y ' r)ak'II enc f Oatc"fimc 1)alefl'imc tMl]Ls11't)ls�!'RACI.i#] <br /> RUINQl N111r])BY ItIXIAVEr)BY Special Ins[ructionsWomments: <br /> Signature Signature <br /> Printed Name Printed Name <br /> C <br /> F irm Finn <br /> Dateffiaw Uateff in+e 1 <br /> Page 25 of 26 <br />