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i <br /> 2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> •�� <br /> Lab: 530,297.4800 <br /> ANALYTICAL ccc Fax: 530.297.4808 Lab No. Page of� <br /> Project Contact(Hardcopar PDF To): California EDF.Report? Yes ED No <br /> �a �G V- Chain-of-Custody Record and Analysis Request <br /> Company/Address: Recunnw cled but not mandatoiy to complete tin seclion: <br /> Sampling Company Log Code: 4 <br /> �e E ew., L - -g�, Analysis Request <br /> Phne No.: Fr N Global ID: <br /> x <br /> �91b� 5a3- rZbS �� 63�-�3�5 Ui <br /> O d N W <br /> Project Number. P.O. No: EDF Deli erable Jo J mai(Address): � � ° m � X �• <br /> �O6 00-7 vAACL a@ dam! a�n%/I Cwt m n w ° Q O <br /> Project Name: / Sam er Signatur oIOZO OD m m CO o t <br /> m N U N C h <br /> Project Address: a s o " N r .o <br /> ! Sampling Container Preservative Matrix @ W N m � _L <br /> 2.4 45 W kAftuwn � � y p � m � iu v � o 2 <br /> L O W o = p g m c c c m o = <br /> W eo W W m m (CO 7 rn rn rn T mOD m N <br /> W O Z H X �cc x X a m <br /> Sample Desi nation Date Time v i v LU z m m r W w >° J N <br /> N41J1 �( I oS X X x �( <br /> tIAW-2, <br /> &- y <br /> hed by: Date Time Received by: Remarks: <br /> G..y <br /> Relinquished b <br /> Date Tim Rprpjve�by- <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> Distribution: White-Lad, Pink-Originator Formslcoc 121001 JI19 <br />