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� o� ,7� <br /> SAMPLE CHAIN-OF-CUSTODY ANALYSIS REQUEST <br /> Shasta Analytical Laboratory <br /> POSSIBLE HAZARDS: 20280 Skypark Drive • Redding, cA 960(12 <br /> 1 p (530) 226-5400 - salab®c-zone.net <br /> Date 1,43 �°( Report to /A)*, ANALYSES srm EDF Report Required <br /> Source of Samples Company <br /> Sampler Name Address �03d^Iti1[:f.N, r.I' , #�rjt7 Global I.D. <br /> Company .#41 A,5 o.W / rIA:t LA T5-,7:41 _ EDF E-Mail: <br /> 1Lr <br /> ' \ Phone: 3JU 3 id 63'7 <br /> w <br /> Project No. �Z,�-+- IC)3- ;LL E-Mail: _S�� <br /> COLLECTION Turn- CONKNTS/COB)I7IONS; <br /> around <br /> LAB ID No. Client ID No. Date Tine Type Depth siite� N4Le time (Container type, container nuaher, ate.) <br /> c� -SC3t - la. 5 <br /> Ie <br /> i�ILt - s6- - a <br /> i2 <br /> 1) Write an1Y one sample rasder in each apace. 4) Preservation of sample. <br /> 2) SPec Hy type of sample(&): Water(W), Solid (S), or indicate type. 5) Wri to each onstyses requested across top. Place an 6X* In <br /> 3) Mark each auple which should be composited in Laboratory as follows: Place an -A• in box for appropriate coli to indicate type of "lysis needed for <br /> each temple that should be composited into one sample; use sequential letter for additional groups. each sample. <br /> SNIPLE RELINQUISHED BY: SAMPLE RECEIVED BY: <br /> Print Mame Signature Company Date "Mm Print Mame Signature Co4aNM DBU Timr <br /> C: -1+ qsj F/775 -6iii <br /> Carrier: <br />