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720 Olive Drive, Suite D <br /> JriJV <br /> Davis, CA 95616 <br /> Lab: 530297.4800 <br /> NALYTICAL eec Fax: 530.297.4808 Lab No. Page I of <br /> Prz,ct ontact(Hardcopy or PDF To): California EDF Report? ❑ Yeo <br /> � , ' s <br /> r--j,&A ;r� A Chain-of-Custody Record and Analysis Request <br /> Company/Address: Recommended but not marKlatpry tocom ttussection: <br /> Sampling Company Log Code: Analysis Request � <br /> Phone No.: y FAX No Global ID: m x <br /> 714 -' 1 ry'7 744n' ::'51 0177 m m <br /> I <br /> ProjecttNumber: P.O. No: EDF Deliverable To(Email Address): � <br /> X <br /> _ m o <br /> ' m o W iLl W N N co <br /> Y C <br /> Projefl Name: <br /> Sampler S'gr'r to e: m _ °~° F - ') O <br /> 11 / CG Mu1 N m o <br /> �� IRS C+- C .t 6-op'L-.-,_ a g m C7 [� o coo Q N N N M <br /> co <br /> Project Address: — a- a ° � o �' 0 <br /> Sampling Container Preservative Matrix o �, N <br /> Q m (7 y o W m m N Co <br /> [/./♦ Ld <br /> o = m o ap m O <br /> �/ 1 [ Q > (Y p� �2 Vi C C C t�O = N� LL <br /> W W U c� <br /> E W 0 Z h X m m C7 m X X v m m v v <br /> L <br /> Sample Designation Date Time z U o o m m F 0 0 0 0 J W " N <br /> 4 <br /> Relinquii§h d by; Date Time Received by: Remarks: <br /> Relinquished by: Date Time Received by: <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> �u <br /> Distribution: White-Lab, Yellow-File,Pink-Originator Formslcoc 121001.fh9 <br />