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amtetuasaida fuoieJoqei 8L9S6 VD 'ulopu] TIEd ssausng OLS imuutuuonnug uootni :laSruviAi porald :laciwnN pmsnp uoppois OZ:01 ZZ/g1/80 :papockql olua Excelchem Laboratories, Inc. 1135 W. Sunset Blvd. Suite A Excelchem ail Rocklin, CA 95765 "---,........... <br />Laboratories, Inc • f Ph: 916-543-4445 Fx: 916-543-4449 <br />CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br />Project Manager <br />4 0 I 4 /1 .q3 4— <br />Phone # <br />11(0 101-331(e <br />Electronic Data Deliverables <br />PDF/Standard Report <br />EDD <br />Geotracker (Gbbal <br />Other .pieasespedyl <br />Request: <br />101 <br />Email Address: <br />obi it? q-cononr“.1,0 4.1 <br />Nil, c e 4,4,400 wow. co. Fax#: _ <br />ii Company/Address rim by, <br />S-to Guti..eri eklek ik, Ch. (10i Project Number/P OS <br />I U (0 S5 <br />— <br />Billing Address: <br />S41441r- <br />ANALYSIS REQUEST Page of <br />Project Location. <br />S fbL.Itt-fb0, 0 <br />.)( <br />Al L. <br />\.., g <br />t., 2 <br />'•••- <br />0 r el <br />t <br />c..) ONLY !Requested TAT 12-u S Bin# <br />Due Date: <br />Project Name <br />Cil(Akruq Cvdi-rtiLD <br />Sampler Name and <br />/-1610-s <br />4.1A-4:cti-1 <br />Metho <br />P eserved <br />Signature <br />(2j4, <br />Matrix <br />Work Order: <br />ID <br />Sampling Container <br />LAB USE <br />Date Time VOA 1SLEEVE [GLAS Sample [PLASTIC C <br />a (-) NONE/OTHER I WATER [sou_ Tr <br />plot?, 1-70 <br />-7, <br />2207177 <br />ffule <br />0 <br />BIN Pt <br />4 <br />Relit= isqn ali vnll <br />24c4- fir DetJ <br />Date Time Received by' ik; i and 0,,,,,I , <br />....i.:.......1 <br />$eV nti 'Ire"' <br />Remarks/Notes: <br />pltik <br />i ett,f al(s ilif- i ,50vt rk fiv-CJ Isal,l , <br />fts4- 4, sru t ic,Lp. fn121- 1000 <br />Relinquished by sx,in zwd pint, Date Time R N c b Laboratory, isoii and unnti