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1046 Olive Drive, Suite 2 Phone#: 916-753-9500 IN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Western Environmental Davis, CA 95616 Fax#: 916-753-6091 <br /> Science &Technology Sample Receiving#: 916-757-0920 <br /> I i�, I <br /> Project Manager: /^ / Phone#: ANALYSIS REQUEST Q <br /> L For <br /> �� ` �r�I7� L a b <br /> Use <br /> � (✓/ <br /> Company/Address: <br /> C4 169/ FAX E.T. ONLY <br /> YO // �LnCo <br /> TOTAL(�j u - <br /> Project (Y"umber: P.O.#: Project Name: _ N Y <br /> o <br /> Colo p�� —`/� __ ✓' a 3 <br /> o N <br /> Project Location: S er Signat re: ' v <br /> C U N N <br /> o a U N z <br /> Container Method r o N N Z <br /> Sampling Matrix Co ru � o Co Co � r- w N o <br /> (Type/Amount) Preserved a u o o 0 o N N g o L <br /> Sample ID a = Cco Co o <br /> (D <br /> C3 p g ry rl <br /> r� W W J X m m co cD cD co co O U <br /> DATE TIME ao w O W Z Q ww = = QQQQQ � <br /> g c� z o o - � a- a_ wwwwa. Qw � <br /> > J J ° _ = U z � co m m r— w w w w w U J U <br /> U) r J <br /> S P- /Y: o'� <br /> bJ-- <br /> l/ <br /> 7d2 �L� <br /> 7 -3J - S /,ST J I I I & z <br /> e nqui ed by: Date Time Rec ved by' I.Remarks: <br /> Relinquished by: Date Time ceiv by: Cgt-• <br /> Relinquished by: Date Time Received by Laboratory: Bill To: <br />