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720 Olive Drive, Suite D <br /> Jrf� <br /> Davis, CA 95616 <br /> Lab: 530.297.4800t5�NALYT/CAL ux Fax: 530.297.4803 Lab No. I Page of <br /> Project Manager: Phone No.: <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Address: FAX No.: For Lab <br /> C ,, !�`�.i ;. E �3 _37 Z-a�.� Analysis Request Use Only <br /> Project Number: P.O. No.: Project Name: W.E.T.(x) hY <br /> Z-1 2, ..� `.�..; tt r' <br /> Co v aNvO l� 3 <br /> Project Location: Sampler Signature: d N TOTAL(x) _ 3 <br /> m m <br /> A _ ^ <br /> Lu Cc M <br /> Cat tgindir— Method x CoCo 0 0 <br /> Sampling (Type/Amount) Preserved Matrix N o (L 0 CM <br /> Co z v• L <br /> o m o 0 m m aN <br /> pi N 4 <br /> O (A C7 m y N N N N N N d t <br /> L <br /> C7 01 � N <br /> Sample W o E o Z LU W _ s< X Q Q �l TJ. e, t <br /> Designation Date Time v i - t _ _ z m m a. a. 0 o 0 o w w v �'�- `� `" <br /> ow <br /> «. Y � t <br /> —12 <br /> e <br /> Relinquished by: Date Time Received by: Remarks: <br /> Relin4 ishe b : Date Time Received by: Email address: <br /> ❑.doc ❑.xls ❑.txt ❑other <br /> Retlnquished by: Date Timet Received by Laboratory: Bill to: <br /> L <br /> Distribution: White-Lab, Yellow-File,Pink-Originator COC.fhB(9/98) <br />