Laserfiche WebLink
• • ! <br /> 720 Olive Drive,suite n <br /> �Vj�ICA <br /> Qavis,CA 35616 <br /> Lab 530 297 4800 <br /> L Lcc Fax 530 297 4803 Lab No jqq_o� <br /> Page / of / <br /> Project Manager Phone No <br /> 530 aw Chain-of-Custody Record and Analysis Request <br /> CompanylAddress (,ties by FAX No F- Far Lab <br /> 3&6 �+RJsrr�ae. S 6 c� ,,gyp C,¢ J,� 6d i Ga l,) Analysts Request use only <br /> Project Number P ONO Email Address <br /> ''�P r� da/ pdt ❑As ❑ doc ❑other m 0 u� n <br /> Project Namekocatlon Samp u m a o <br /> m o m oas <br /> it 1oc1 r O UI W N Y G C n n <br /> ontalner W <br /> Method W h .. m b w <br /> Sampling CrypelAmount) Preserved Matrix M $ '° E a e E <br /> x = m is m 4 4w) ch <br /> 6 <br /> 5 co <br /> M nSam ie ° <br /> LU <br /> a3 <br /> iW IX <br /> Designation z 0 o o 0 11Date Timeco z ? <br /> r� +a n w yw H A 7 l`' <br /> Rj - 0- 1� y- E IAOx x s <br /> 81 - 6- :zq' 1XI ISI I I I I L <br /> jhw713-- 13 k-P-01 dftu ;K 7 <br /> ITT— L <br /> Rai h y' Date Time Received by Remarks <br /> R nquished by Date Time Received by <br /> Ya <br /> Rellnquish Date rime Recelved by Laboratory Bill to <br /> 6f 1101 16 31 �,{•F <br /> Distdbuthm MAW-Lob Y94bw Faze Pink Onprnator COC rho 15=I <br />