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2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> r <br /> ANALYTICAL cee Fax: 530.297.4808 Lab No. Page of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑ Yes Lr' No <br /> Chain-of-Custody <br /> Record and Analysis Request <br /> d f�r 3r" (..-CFfi tiCHJF' <br /> Company/Address: , r Recommended but not mandato totem letethissection: � <br /> Analysis Request <br /> r^� L Sampling Company Log Cade: <br /> A <br /> Phone No.: FAX No.: Global ID: <br /> in m m LO <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): �s' X m � x c <br /> Project Name: Sampler Signature; o W 2 _ o m w r <br /> r a0 m (5 C7 m ro 4 m m n <br /> _ trr_+,r~ �� •i! �.-"i;�` Vit`''- g m Sd a_ N a`~vo �p 9 <br /> n-- <br /> Project Address: Sampling Contaier Preservative Matrix mm d V 0 Mcv <br /> Om m m ro LLN S T mi <br /> O W V + �' 4 A y ami m o) 04 <br /> _ N <br /> J ] 1 ���'. (n 0ro ro C7 rn rn rn Nm <br /> _ M W W X x o a0 v <br /> ELU �+ U W O `� O w a a CL O O D O m a o m N <br /> Sample Designation Date Time 4 � �?�; � � v z � N ro m � � � � ^ ' " J '� ' J <br /> r <br /> Relinquished by:-l Date Time Received by: Remarks: <br /> Relinquished by: Date Time Received by: <br /> 1 _— —�-- -- – -- 1 <br /> Relinquished by: hate Time Received by Laboratory: Bill to: <br /> _ �,_ .__—_�—..r_.--._—�—.... •-�_.,.,"� 1�r�L -''\ ,4_rj V s ! 4 r ,1.1`x'���'!r, b1' � <br /> Formslcoc U1001.M <br /> Distribution: White-Lab, Pink-originator <br />