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/FF Davi 2nd Street Suite 300 <br /> Davis,CA 95616 <br /> Lab 530 297 4800 Lab No Page of <br /> IL ANALYTICAL ccc Fax 530 297 4808 <br /> Project Contact(Hardcopy or PDF To) California EDF Report? Oyes El No Chain-of-Custody Record and Analysis Request <br /> Jennifer Worsley <br /> Company 1 Address eoommended but not mandatory to complete this section Analysis Request Q <br /> Apex Fnvirotech,Inc Sampling Company Log Code H <br /> 11244 Pyrites Wy Gold Rver CA 95670 APEF <br /> Phone No Fax No Global ID o ❑ 12hr <br /> 916-851-0174 916-851-0177 T0607736979 0 w 0 <br /> Project Number PO No EDF Deliverable To(Email Address) m 24hr CO M 1 <br /> NWP01 004 rwestrup apexenvirotech com 00 8 8 L ❑ 0 0 <br /> Project Name Sampler a a ip <br /> New West Petroleum Si nature m 48hr <br /> g Y m m -- a 0 s <br /> Project Address Sampling Container Preservative Matrix r M N o p o 72hr 3 <br /> O y t °` `°CL <br /> N �' m 0 0 <br /> 6437 W Banter St,Lodim�, _ o m 1 Wk <br /> ill P O 2 rn C C G 8 = a 0 <br /> Sample ' W } W M w W m � � � 8 N <br /> E a m o z -! X 2wk <br /> Designation Date Time Mt (n a ¢ z i v z° cOn m m a O O 0 <br /> CSA-31-1 I Nd i X X X X X 1 wk `0 <br /> CSA-31-2 -�-- I no X X X X X 1 wk :0 <br /> I <br /> 0 <br /> Reiln wished by 4DateTime Received by Remarks <br /> c 1 la al Temp-C t Ttorin roes <br /> Re1tKq abed by Date Time Received by Initial <br /> Dam 1 tt TIS. t' y 1 <br /> Coolant Aressne No <br /> mquished by ---_` Date Ti el Receivedby Laboratory Bill to <br /> f'l�f i <br />