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2795 2nd Street, Suite 300 <br /> /FF Davis,CA 95616 .� <br /> Lab: 530.297.4800 <br /> ANALYTICAL LLC Fax: 530.297.4808 Lab No. 73 Page of <br /> Project Contact(Hardcopy F To California EDF Report? ❑ Yes ❑No <br /> I+G tN S Chain-of-Custody Record and Analysis Request <br /> *.npeaN <br /> n lAddress: I�Z(� Recommended but not m to completeiissection; <br /> s Sampling Company Log Code: <br /> Analysis Request <br /> o.: FAX No.: Global ID: m x <br /> S l�G 1 sl ol�� i m m 0 <br /> o C3 C3 C <br /> Project Number: P.O. No: EDF Deliv le To(E it Address): co V m o <br /> 00 M fi] m x x L1 Co X A <br /> llJ LLk w N x <br /> m m ¢ a 0 <br /> a <br /> Pro• ct!Name: /]p�� Sampler Si ur � � � f � � � <br /> C 1 W W Z3 m w m Q a L <br /> Q 5 00 0 0 mo CD Q m N � <br /> Project Address: 2 a a N ° o o <br /> Sampling Container Preservative Matrix @ o ,� : tz S �, 2 r <br /> a m �I y F UI fq N y] v v V (�1 P] L <br /> '{4`L/,/■[{yy�fr 171'fJ!� 1C 0 m U] N N 0 N C <br /> O > IY d vi C C c O N LL <br /> E w O Z LU <br /> -� t [7 m rn a m v N <br /> Sample Designation Date Time U) m i v z N ►- a 4 a o 0 0 0 0 a o a N <br /> 0] In F N F- L1 n Ln � J W � J <br /> 11.11-t z I�0o NL I <br /> f _ -)2, — 1A) 0.'to <br /> Relinquish b Date Time Receiv d by: Remarks: <br /> Relinquishe Date Time Receiv d by: <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> Distribution: White-Lab, Yellow-File,Pink-Originator <br /> Forms/coc 121001.fh9 <br />