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2795 2nd Street, <br /> Dav <br /> CA 95618 <br /> Sui <br /> KI AnalytFF uc Lab: <br /> 530 297.4800 to 300 SRG#/Lab No. �� C Page _ of <br /> Fax: 530.297.4802 <br /> Project Contact(Hardoopy or PDF To): California EDF Report? El Yes F41 No Chain-of-Custody Record and Analysis Request <br /> Matt Cohen <br /> Company/Address: Sampling Company Log Code: Analysis Request ITATI <br /> 3050 Industrial Blvd,West Sacramento,95691 PLEASE CIRCLE ❑ <br /> Phone Number: Global ID: - MSTHOD <br /> (916)372-1434 � 12 hr <br /> Fax Number: EDF Deliverable To(Email Address): < g a <br /> 916 372-2565 w m .� o n <br /> Project#: P.O.#: Bill to: m u I m 24 hr O` <br /> 90411.01P Wallace Kuhl&Associates m a $ a w 148hr �Project Name: Sampler P'nt Name: o wCity of Manteca UST Removal Don U raftw _Samp r S' o m Z w m w0 l <br /> mlin ;Project Address: Sa <br /> 320 Center Street w $ in o 72hr <br /> Manteca,California a N � w � m � g � <br /> > > w W N N W x U' o T W d - d m m f: c ❑ <br /> o e1 o t0 8i U Z o ni w 4/ �` O <br /> Sample Designation m a o o a a a 3 u o 3 a 1 wk <br /> tlon Date Time a w a C7 F x S z 3 rR ¢ f m > > > r <br /> S-1.STY, 3/4/2011 (to' x x x x z x z x x x x 48 hr v l <br /> S-2 3/4/2011 U10 x x x x x x x x x x x 48 hr 2 <br /> S-3 3/4/2011 It y< x x x x x x x x x x x 46 hr 03 <br /> � <br /> -C(-s-p< ?/M/tr ow x X x x <br /> Relin ished y: Date Time Received by: Remarks: <br /> �l C r rho <br /> mquished by: Dale Time Received by: <br /> linquished by: Date Time Recely by L bo ory: For Lab Use Only: Sample Receipt <br /> 3ey1I ) I 1 f Temp'C Initials Date Time I Therm.ID# Cp nl P' - <br /> J /4 nQ [ I Yes / No <br /> DisWon: whte-lab:Pail,-Originator <br /> Rev <br /> : 061708 <br />