Laserfiche WebLink
720 Olive Drive, Suite D <br /> Davis,CA 95616 <br /> Lab:530.297.4800 <br /> ANALYT/CAL i.cc Fax:530.297.4803 Lab No. 900 Page of <br /> Project Contact Hardcopy or PDF To): EDF Report? ❑ Yes ❑No <br /> 7-0 IN^ f-�'e-9'0� Chain-of-Custody Record and Analysis Request <br /> Company/Address: Recommended nutnot mardatM to complete uilssection: <br /> / to�IuGZ v� <br /> AS-c- t^ 4 � Sampling Company Log Code: Analysis Request � <br /> Phone No.: FAX No.: Global ID: m x <br /> 916 3 4-z IY3�/ W4,2 Z 9 0�� o a N <br /> W <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): �_ � S no in <br /> 04 <br /> m 0 <br /> C� o W W N x Y C <br /> to m m m Q 3 <br /> Project Address: Sampler Signature: co a- 0 0 <br /> N N m o w <br /> d wCS' J=r a `%`1 ;�� o m N v y to ti M <br /> Pso ect Name: — a A N S o =_' CU <br /> je s r Sampling Container Preservative Matrix y o y v „ r <br /> t7T tnl a i'+!�/�b r I Q o] O N o ayi a� °= LL i4 cM v J <br /> o m ° O <br /> W � d N c a c y m mo = N t LL <br /> Sample W o LU Z x R m m N N <br /> Designation Date Time n = _ °z ° F F 0 0 0 0CL <br /> m t <br /> �wi y <br /> Mw -� <br /> Tf T J <br /> Relinquishedby: Date Time Received by: Remarks: <br /> �?'; /7 tl Z <br /> .Relinquished by: Date Time Received by: <br /> Relinquished by: Date Time Received by Laboratory: ' Bill to: <br /> 1 <br /> o7'/9a c <br /> Distribution: White-Lab, Yellow-File,Pink-Originator Formslcoc I z i OO i.fh9 <br />