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P <br /> SAMPLE CHAIN-OF-CUSTODY ANALYSIS REQUEST �_P� <br /> Shasta Analytical Laboratory <br /> 20280 Skypark Drive • Redding, CA 96002 <br /> POSSIBLE <br /> ^^HAZARDS: (530) 226-5400 • salab®c-zone.net <br /> ANALYSES <br /> Date /t-Y - ��� Report to ��lr1C� sTm EDF Report Required <br /> Source of Samples .9nrL,v4 Company s Global I.D. <br /> Sampler Name MA-cs,j Address <br /> Company EDF E-Mail: <br /> /7' 1 <br /> Phone: <br /> Project No. E-Mail I • <br /> COLLECTION Turn• COMMENTS/CONDITIONS: <br /> Compo- Mote erourd (Container type, container number, etc.) <br /> LAB ID Mo. CLient ID No. Date Time Type Depth site < ties <br /> l 11 v - S '5- Sdal $Ta }C <br /> r_I�lAf -s3-s- o / <br /> tin-'— CA- - n <br /> x_11' ILM 1G, <br /> 1) Write only one sample saber in each apace. A) Preservation of seapla. <br /> 2) Specify type of saple(s): Water(W), Solid (S), or indicate type. 5) Write each analysts requested across top. Place an eXa In <br /> 3) Nark each sample Aich should be composited in laboratory ss foLLous: Place an -A• in box for appropriate colon to indicate type of analysis needed for <br /> each sample that shoutd be cotposited into one sample; use sequential letter for additional groups. each sample. <br /> SAMPLE RELINQUISHED BY: SAMPLE RECEIVED BY: <br /> Print Hame Signature Capery Date Time �y Print Mame Signature <br /> Company Dau Time <br /> 411 � �4 lr L,( iN4 n7c_ _ 7� IL <br /> tr—C. <br /> Carrier: <br />