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720 Olive Drive, Suite D <br /> IFF Davis,CA 95616 <br /> Lab 530 297 4800 ' <br /> ANALYTICAL ccC Fax 530 297 4803 Lab No 2-11 Page/of <br /> Project Manager Phone No <br /> /6 -3 5 `- Chain-of-Custody Record and Analysis Request <br /> Company/Address PO 13o n ff 9 FAX No <br /> H Gh o 041 r47:pi- G/7 9t,16 - -3 6 6 Analysts Request <br /> Project Number PO No Email Address m X <br /> 0 <br /> ❑ pdf ❑ xis ❑ doe ❑other co m co W <br /> Project Name y Sampler Signature ° °co In <br /> c �+ <br /> Project Location -- m o t a <br /> N a R N M <br /> Sampling Container Preservative Matrix o N N N v a �, J <br /> Q y o m v o £� O <br /> w Na O c c c R QU. <br /> Sample � M co to <br /> 0 0 9 " <br /> Designation Date Time a z s z o m m F o 0 0 0 UJ J <br /> X <br /> "02 <br /> 71— <br /> Relinquished b Date Time Received by Remarks <br /> ehnquished by Date Time Rec wed b <br /> Relinquished by Date Time Received by LaboratoryZ Bill to <br /> V2.1*.7I ' 't <br /> Distnbution White Lab, Yellow-File,Pink-Onginator Formslcoc 062801 th9 <br />