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SAMPLE CHAIN-OF-CUSTODY ANALYSIS REQUEST <br /> f r�� <br /> 6�G Shasta Analytical Laboratory <br /> POSSIBLE NAZANDS, <br /> E39)-� • ulabQc-zone.net <br /> Date L JG Report to ��� A>7� ANALYSES REQUESTED <br /> EDF Report Required <br /> Source of 3aeples 3Y2//YCS Coepony Aifftk 44A�OC44. <br /> Sampler Name Address _ zi)s5-0 Ac-AJCrI AP Global I.D. <br /> Company A"4,6g`d 6 Qi a& EDF E-Mail: <br /> Phone: .�J- . � ZZ00 <br /> Project No, - 2 E-Mail: 204C..IC <br /> COLLECTION iwn- CQgEI1Ti/CONDITIONS: <br /> W ID NO. Client /0 No. mete Tim T D <br /> Co"- Note erovaf (Container type, container tatsber, sto.) <br /> Ype epth site 4 ties <br /> v_ gal - YL i2k3 � s�A -tlDz <br /> -�*- 2 <br /> - - *-3 -Yz' <br /> Berl- <br /> B4J <br /> O - sa 1. 'N•' V <br /> 1) Writs only one Bevis nombor in each space. 4) Preservation of maple. <br /> 2) Specify type of sayle(e): Wtsrtm), Solld (S), or indicate type. S) Write each onslyses <br /> 3) Nark each sample Which should be co.pmtted in Laboratory as follows: Place an NAN In boa for late colun torequested <br /> f�nd1 atst� tap.analysis <br /> se e%' in <br /> each sample. type of wlysis nasdd for <br /> sadl simple that should be caaposlted into en Bayle; use sequmtf at letter for sddlttonal grapes. each septi. <br /> ZMVLE REL1Nd11fNED BY: SAIPLE RECEIVED BY: <br /> Print f t Coynry Date Tim Print Nape Signature Coaprry Date Time N <br /> O) <br /> T- CO <br /> 0\ L, �fl \WAt11, `IINIIw C.�c� 1 a <br /> � <br /> Carrier:- GIN <br />