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720 Olive Drive, Suite D <br /> rf� <br /> Davis, CA 95616 <br /> Lab: 530.297.4800NALYTICAL ccc Fax: 530.297.4808 Lab No. Page or <br /> P ject Contact rdcopy or PDF To): California EDF Report? [7 Yes ❑No <br /> Rices 6PQ so N Chain-of-Custody Record and Analysis Request <br /> Company/Address: '' Recommended but not mandatory tocomplete thNssecdon: <br /> ��nM�V t� TF-c i1 5 sampling Company Log Code: Analysis Request � <br /> Phone No.:: IW f FAX rNlo.: Global ID: m X <br /> I-7 �- E (D m <br /> E w C <br /> FaAoz, <br /> ct NumbeP.Q. No: EDF Deliverable To(Email Address): � � � m o VV m o ul u! w cfOv X �c !ti <br /> Pr 'ect Name: Sample Si nature: C3N m N a ¢ 3 <br /> ca <br /> Project Address: C14 S Matrix � -0 Sampling Can iner Preservati0 <br /> LL-A Q t 00 <br /> t <br /> 0O <br /> w W LLL! ~ O @ 0 0 rn y N y ti LL. <br /> v <br /> E W O z F J X m m C'J a m <br /> J W U Z U O ¢ E a a a O O O O a o N <br /> Sample Designation Date Time v cn x z _ z m m F w, LoW <br /> A- 'o-g 4z 17,'00G1 <br /> f1 —j�68 — /N /off-oz mt <br /> I F,_ <br /> Rel i qu hed y: Date Time Received by: Remarks: <br /> 6011 — — <br /> Relinq fished by: Date Time Rece' y: <br /> Relinqu hed by: Date Time Received by Laboratory: Bill to: <br /> o ye). 1315 1 <br /> Distribution: White-Lab, Yellow-File,Pink-Originator Forms/coc 121001.rh9 <br />