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no-1 F.:3 ,.., . <br />.. . 1135W. Sunset Blvd. Suite A <br /> <br />Excelchem Las, Rocklin, CA 95765 <br /> <br />- - 16-543-4445 Fx: 916-543-4449 <br />CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br />Project Manager: Kate Albertsen — Phone #: See above _ <br />X _ <br />Electronic <br />.PDF <br />Geotracker <br />Other: <br />Other: <br />Data Deliverables <br />,Glot1;11,D) <br />EDD for EQuIS <br />Request: Email <br />Please <br />Address: <br />JoeTpexcelchem.net <br />KateAf@excelchem.net <br />Company/Address- See above Fax #: See above X <br />X <br />invoice to: <br />ChrisCgexcelchem net Excel Sp eadsheet <br />ANALYSIS REQUEST Page of <br />Project Number/P.0#: 2207177 Project Name: 2207177 <br />x el 1- <br />o <br />o <br />›- a o <br />Le = <br />Bin#: <br />Due Date: <br />Project Location: Rocklin, CA Sampler Signature: <br />Work Order: <br />Sample <br />ID <br />Sampling Container Me hod <br />Preserved Matrix <br />LAB USE <br />ONLY: <br />Date Time <br />14., <br />0 o Amber 1 III Glass Jar 0 z NH4OH/(NH4)2SO4 ICE/COOL TO 4C SOIL WATER ' <br />13111012 07/20/22 11:00 X X X X X <br />Relinquished by: ..,c. <br />ditrZiki0ei EXce/clowl 4.Lorai;eies <br />Date Time Received by: <br />/1./.' -OCZ e-- 7)7 ii <br />Rema ks/Condition of Sample: <br />McCampbell - 925-252-9262 <br />-( ffday TAT-Quote 222504 -74‘Alt q i( <br />Relinquished by: by: Date Time Received by Laboratory: <br />Lig/de <br />GiAvezte.Ar_,Bill <br />1 104- <br />To: Excelchem Laboratories <br />Page 8 of 9