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720 Olive Drive,Suite D <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL L.1-C Fax:530.297.4803 Lab No. L Page of <br /> Prolept Manager: Phone No.; <br /> M A-r-r� -n -"/' /& 3 �2 ( 4 Chain-of-Custody Record and Analysis Request <br /> — <br /> Company/Address: FAX No.: For Lab <br /> &L)-/, (/Ii Cc- - zm- 37 2, '906 _5 Analysis Request use owy <br /> Project Number: P.O. No.: Project Name: Y W.E.T.W <br /> /& 2- S N N <br /> S R N <br /> Project Location: Sampler S/inatur X TOTAL(X)� <br /> IF <br /> co <br /> Container Method <br /> Sampling (Type/Amount) Preserved Matrix EL a. <br /> Co Co <br /> U) <br /> V <br /> CO 0 p 6 24 Q N <br /> co co <br /> LU CO 15 <br /> (1) a. <br /> 0 co N CIJ <br /> - a <br /> Sample > w 0D M t- <br /> LLJ 15 <br /> E W X F F" F <br /> 0 w z LU 1: M M <br /> Designation 0 z 0 1-- EL a. 0 0 0 1 9 -6 <br /> Date Time 4 u) 0 X X z J-- 0 1- 0 t-- I 1 0 <br /> Ln <br /> /4 <br /> Z. <br /> A S2 <br /> 53 nti !+ �, �i r 1 til <br /> Relinquished_by-. Date Time Received by: Remarks: <br /> 311 c/ <br /> Relinquished by: Date Time Received by: Email address: <br /> 11,doc EI.xis D.t>ct 11 other <br /> Relinquished by: Date Time Rh,e i,ved by o tory: Bill to: <br /> Distribution: White-Lab, Yellow-File,Pink-Originator COC.fh8(9198) <br /> —------------------------- ------ —-—--—---------------------------—-------------------------------------- <br />