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720 Olive Drive, Suite D <br /> IFF Davis, CA 95646 <br /> Lab: 530.297.4800 ' <br /> ANALYTICAL eec Fax: 530.297.4808 Lab No. page of <br /> Project Contact(Hardcopy r PDi=To): California EDF.Report? ❑ Yes ❑Ivo <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Address: Z:f( Recommended but notrrkndat n,to cothis section: <br /> AKXE-10 �a0T❑E11 <br /> CH (f `�f � Sampling Company Log Cade: /analysis Re' quest <br /> Phone No.: FAX No.: Global ID: m x <br /> _ S�- of 7- m CN Li <br /> O0 Co [7 N llJ <br /> co <br /> Project Number: P.O. No: EDF Deliver ie To(Email A ress}: cc � m o <br /> 2100 m V <br /> N (O F <br /> CM <br /> Project Name: Sampler Sign ture: � m r ¢ <br /> }� p v) cn m a o a <br /> t frac d�` �� c w M m o w r <br /> O m (� C7 o co Q N a N <br /> Project Address: _ a A N V o _J o N a <br /> l� Sampling Container Preservative Matrix @ o , r- _ m v �, <br /> � "- Co <br /> v <br /> N = O <br /> 1 0 a C3 D N C C C 6 = N L LL <br /> W 0 Z �- -J. K 1 N N {� m al 7+ N qNp m <br /> - Lu <br /> Sample Designation. Date Time � � z z ° <br /> E. <br /> P a- a. Q, o o 'o o a r <br /> CC <br /> — m rA H F H u� u� 1� r LLI0- 7 0 r <br /> 12-00 <br /> - OI0 0 l�r-7 -V-4& 2= <br /> Relinquished b Date Time Received by: Remarks: <br /> V7� <br /> Relinquished b Date Time Received by: <br /> Relinquished by: Date Time ReceivedbyLaboratory: Sill to: <br /> Distribution: White-Lab, Yellow-File,Pink-Originator <br /> Formslcoc 121001.th9 <br />