Laserfiche WebLink
Y <br /> 720 Olive Drive,Suite D <br /> /FF Davis,CA 95516 <br /> Lab.-530.297.4800 <br /> AIVALYT/CAL LLc Fax:530.297.4803 Lab No. l V [ Page of <br /> ProjectManageo ° � Chain-of-Custody Record and Analysis Request <br /> v <br /> mpany! ddress: FAX No.: i— For Lab <br /> �x /s2 W>Bre+a6.F �Q �_ 3��1_�3s Analysis Request Use Only <br /> Project Number: P.O.No.: Email Address: , r 1„ m in m r 9 <br /> ❑.pdf ❑.xis ❑.doc ❑other °M� co w a 4 <br /> 04 04 <br /> Project NamelLocation: S+ Sample ignature: 0 Ja <br /> m g N <br /> m $ " <br /> Xx <br /> r W � W W X <br /> r u, Tn m <br /> (-Vol Cont r Method W "' W m m a N <br /> CL CL <br /> Sampling (Type/Amount) Preserved Matrix m �_ s = m o ?_ <br /> B A <br /> Q N YGq c �5q° p0 M N L t m m m m <br /> W Of <br /> v CQO Q � N U <br /> W r �� v Jr <br /> sisdp,SamPle �f0NNe' SmW Q oU z <br /> Designation Date Time ,10 z 0- CL 0 <br /> N " <br /> iN —513 2,Q r !� _o <br /> s <br /> Relinquis by. Date Time Received by: Remarks: <br /> Relinquis d by: oa Time Reoeived by: <br /> Date Time Receiv by Laboratory: Bill to: M �r � <br /> Relinquished by: L,IF <br /> Distribution: White-Lab,Yellow-File,Pink-Originator '2 120 ( 0 b / A V t-- ! [��/ COC.thB(5/00) <br />