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720 Olive Drive, Suite D <br /> Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL ctc Fax 530 297 4803 Lab No l Z Z ( Page of <br /> Project Manager Phone No <br /> 'I ^ r n —57_31) - Zi-lo Chain-of-Custody Record and Analysis Request <br /> Cc panylA ress FAX No r For Lab <br /> C !� fGL 2,1 IL Analysis Request use Only <br /> Protect�be PO No Project Name <br /> �� 0 N N weT{x} <br /> 4 <br /> �' <br /> TOTAL Co 3 <br /> Protect Location 5a pier Si ature a m In- <br /> Z?m <br /> --"q eA <br /> 00 <br /> Method :C <br /> o � o � <br /> Sampling (TypelAmount) Preserved MatrixM o t a- � z <br /> M <br /> 0 C7 o m aS OD <br /> mi a"�i N v <br /> Q UJ N O Q C C C C W O i 0 Y <br /> O W in (� �' N N Oi 0 V� OI N N V 0- <br /> co N <br /> Sample � � o U Z LU Q = = 0 0 0 9 co <br /> ti <br /> Designation Date Time v z z U z m m :- w W v <br /> 'P-z- �%� i e X - <br /> —FT7+ I <br /> ............L............I J <br /> R linq ed by Dale Time Received by Remarks <br /> quiS ate Time Received by Email address <br /> -_ - -- - - --- _-- ❑ doc ❑ xis ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to <br /> COC ma{area} <br /> Distnbution While-Lab Yellow-File Pink-Onginator <br /> I <br />