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2795 2nd Street, Suite 300 <br /> .�� Davis,CA 95616 <br /> Lab: 530.297.4800 roc 3WQ3 <br /> ANALYTICAL c Fax: 530.297.4808 Lab No. . Page of <br /> Pro'ect Can act Hardcop or PDF o): California EDF.Report? ❑ Yes ❑No <br /> N Chain-of-Custody Record and Analysis Request <br /> mpany/Address: Rwwvrw tedWrlot E@nALbn to complele MaKfion: <br /> VIn, T6 Sampling Company Log Code: }- <br /> fC_(J f L� c/ Analysis Request � <br /> Phone No. FAX No.: Global ID_ <br /> l-oly �G SI-�I X <br /> r n " Ld <br /> w <br /> Pro'ect urrlber:///y^j P.O. No: EDF Dellv ble To(E all Address): �(o Xo <br /> 0 -V�/ m o 111 11J w N X <br /> Y r. <br /> Pr ' ct nN�arne- 1 p Sampl Sig atur � m r Q a O <br /> w �_ w c a o w ui <br /> O m 0 0 o to Q w N <br /> Project Address: — ~ a a � o 0 1 0 <br /> tJ Sampling Contains Preservative Matrix o m y A M r <br /> B a �// m 9? o <br /> J 0 to C^ a a O lL <br /> E W Z N + m m C). a m m N <br /> Sam le Designation Date Time v rJn z z a F o o O m w a n <br /> ~(JG05- FF - o. it.3o 61 <br /> 02. <br /> Relinqui ed b : V <br /> fDate <br /> /Time Received by: Remarks: <br /> Date Time Received by: <br /> !R ' q ate Time Received by Laboratory: Bill to: <br /> Distribution: White-Lab. Yellow-Pile.Pink-Originator <br /> Formslcoc 121001A9 <br />