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2795 2nd Street, Suite 300 <br /> f <br /> �� Davis,CA 95616 <br /> Lab: 530.297.4600NALMCAL,ccc Fax: 530.297.4808 Lab No. L4 Page--t—lof <br /> Project Contact(Hardcopy or PDF To): California FDF Report? KYes f7 Na <br /> e r Chain-of-Custody Record and Analysis Request <br /> Company/Add ss: ��1� Reoomme xW but not tlis seco n. <br /> Sampling Company Log Code Q <br /> �3rG c� Analysis Request <br /> Phone No.: FFAXo.: diabal ID: p o x <br /> P.Project Number: / <br /> EDF Deliverable To(Email Address): X mm m o �, <br /> Gi G -� o uJ !U m N x rf ) <br /> r <br /> Project Name: Sampl Sig tur i~ m m �: a <br /> ,I c!2 m ¢ - w o <br /> Project Address: /�'7(o am lin _ a a CO X m t -J s <br /> ampling Containe Preservative Matrix _ <br /> Cn <br /> m Z O <br /> IM CY <br /> in <br /> S�CPLG 771L�! X�X 'L H SmQc� d m T a L LL <br /> ro W W J W 17L a 0 a m <br /> Sample Designation Date Time a cwo = x U Q o m a -"o <br /> Adf <br /> OD <br /> /f,'V -o3 <br /> y z0 d l0; <br /> -4' .0-7 <br /> -03 <br /> -1c 1c <br /> Relinquished by: Date lime Received by: Remarks: <br /> Relinquishe Date Time Received by.- <br /> Relinquished <br /> y:Relinquished by: Dale TimeRec ved by boratory: ail;to: <br /> 64 310 �4 F �ra�y}-�m0 6't AT <br /> Distribution: White-Lab, Pink-ariginalor Fomtislcoc 121001.fi9 <br />