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720 Olive Drive, Suite D <br /> .�� Davis,CA 95616 <br /> Lab:530.297.4800 <br /> ANALYTICAL LCC Fax:530.297.4803 Lab No. 1 �_ Page of <br /> Project Manager: Phone No.: <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Address: FA)(-No.: <br /> �- For Lacs <br /> Analysis Request Use only <br /> Project Number: P.O.No.: Project Name: a W.E.T.(x)co Y <br /> Project Location: Sampler Sig itur o IJu TOTAL(x) <br /> Y <br /> G N h = <br /> Co ainerMethod in a 10 6 0 o o ti <br /> Sampling (Ty a/Amount) Preserved Matrix g cc <br /> N NN <br /> W m z t <br /> w O t c, co <br /> J _ a] C <br /> U} Q O <br /> o U g o d) cu a] W ii L <br /> > > 0 wSam <br /> Designation eo ul Q z o P a a 0 0 0 0 a- � N <br /> Date Time v U) t- �, s z _ z m m F- F- <br /> IS ti w w J U <br /> I <br /> Reiinquis by: Date Time Received by: Remarks: <br /> Rell quishe by: Date Time Received by: Email address: <br /> ❑.doc ❑.xls ❑.txt ❑other <br /> `Relinquished by: Date Time Received by Laboratgr Bill to: <br /> 0&16 0o <br /> Distribution: White=Lab, Ye!!ow-File,Pink-Originator `lff=OC.fhB(9198) <br />