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720 Olive Drive, Suite D <br /> Davis, CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL ccc Fax:530.297.4808 Lab No. 26�5-3 U Page--z-of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? Yes ❑No <br /> r �r La Chain-of-Custody Record and Analysis Request <br /> Company/Address: 94 ►, A 060 a 0&e4CL Recommended but not mandatory to compLew this section: <br /> •+U�✓6-eosC- '0� r' [ Sampling Company Log Code: }' <br /> 1�Ior,l.P—v Pe, �'1 <br /> 1/ 35, uc Analysis Request <br /> Phone No.: 1 FAX No.: C7Global ID: 0 x <br /> m mto <br /> Lq <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): 2 S S m o �, <br /> m m m a c <br /> N � <br /> Project N me: Sampler Signature: �� '� m y N co ~a o¢ o H <br /> J /� o W r t <br /> i�LtJGa-re-, i(-_ C L n 'wm [? C7 o civ U �' c 'N` <br /> Project Addr ss: — n a i m J -e N t m <br /> Sampling Container Preservative Matrix y o t r N m <br /> ya/-c1.�I lv, f'r�r*=4•• m w +� cs <br /> 0 Ing N ? O <br /> LU z Ud J X U. <br /> O N �' OI Cn O/ T N N y ti N <br /> � U ZZ w p 4 p` w u� x x z O O O O ro ¢ r <br /> Sample Designation Date Time v rn z v z U) m m a � �, t- 0 r- � w � <br /> 17;16 x _a <br /> — .S` z Q,z l7 ad <br /> Relinquis by: ate Time Received by: Remarks: <br /> -14 /,S. <br /> Reli ished Date Time Received by: <br /> Relinquished by: Date Time Received by Laboratory: off•' - Bill to: <br /> eS3 D 15 5 �•' �r/ /� <br /> Distribution: While-Lab, Yellow-File,Pink-Originator Forms/roc 121001.fh9 <br /> I'. <br /> IE <br />