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2795 2nd Street, Suite 3o0 <br /> IFFDavis,CA 95616 <br /> ANALYTICAL tcc Lab: 530.297.4800 <br /> Fax: 530.297.4808 Lab No. ZZ 164-- Page of <br /> Project Contact(Hardcopy or PDF To): CallfOrnia EDF.Re' po' rt? Yes-.❑No <br /> 50 Chain-of-Custody Record and Analysis Request <br /> Company/Address: „ , <br /> f�„7—CC-11Analysis <br /> Company Log Code: Analysis Request <br /> Global 10, o <br /> sC 1►7 t t' 'n m iii r <br /> Project Number. P06 _ .O.No: co ° m 3 <br /> �� EDF Dally To(i:mal ddress): 2 S S m a <br /> r� X <br /> W N �c C <br /> Project Name: Lo <br /> ` Samp tore: i m m 0 N Q � 3 O <br /> Q <br /> /060 Ad Co <br /> Project Address: � � � x z oo � 0 <br /> R f Sampling Co Iner Preservative Matrix q o a o — t <br /> N 7 o' <br /> Q �i m w yr a m � c� c+ <br /> _ m. pip � <br /> O M fil 13101TI: <br /> fJtLQ11J Z J• m C7 to m O �.Sam le Desi tlatlon Date Time Q z = U o a a o 0 o aQ5 m m F h H Ln P Lo 1� J (�l <br /> �-li- r r1 i <br /> w <br /> Relin i head y Date Time Received by: <br /> Remarks: <br /> j�-ate rdime 1.L� T� 2 H a DES <br /> Relinquis a.ay: Date' Time Received by: <br /> Relinquis <br /> _heN by. Date Time ReapivreV by aborato <br /> 1` , AA, <br /> Bill to:a3IZ03rrr <br /> Distribution: White-Lab, Yelbw-File,Pink-Originator <br /> Formslcoc 121001.fh9 <br />