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i <br /> 2795 2nd Street, Suite 300 <br /> Davi <br /> CA 95616 <br /> rt� LLab:530.97.4800ALYT/CAL ccc Fax: 530.297.4808 Lab No. 3 9/9 Page / of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑ Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Co pa /Address: H� SampReoomling <br /> C mpaut to complete tlussection: <br /> cif '�_W'�K1/// Sampling Company Log Code: Q <br /> FI-11 V 14 Analysis Request <br /> Phone No.: FAX No.: Global ID: in x <br /> S3,) _ o <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): ° ° m o �. <br /> 021.-3Z0 m W � 3 0 / <br /> Project Name: Sampler re: $ �' ° m Co m ,� w ° <br /> W to W N N o F t <br /> �p o m C7 C7 mo co Q N h � <br /> I- F- _ = fp N U c _ <br /> Project Address: _ a ° ° - N L 1° <br /> 1 Sampling Conta Pre tive Matrix o �, N 00 <br /> -i <br /> m 0 y o H 5 5N N N A LL_. 9 N v 0 <br /> Q N p2pO m i0 c0 2 C > Co fft o <br /> O Wco <br /> co W W m U� m rn rn Tto <br /> N LL <br /> _ J J( T T <br /> p J U Z W 0 Q O H h- a a a o O O 0 y a O 1° L <br /> Sample Designation Date Time a cn = z z cn m m to Ln r, W > I -J <br /> S- 3 F -v <br /> -03 <br /> 3- F / <br /> S-3 F-b 5 .n <br /> S - LI - PL ► / -o(� i <br /> S-- y - PL3 X ! <br /> S - y - PLS / <br /> .09 <br /> Rellnqua y: Date Time Received by: Remarks: <br /> Relinqu' b : Date Time Received by: l r"P c �' v �l`�t yt -0"- ?r <br /> ce� I 1 l ae4de-es s <br /> Relinquis Date Time Received by Laboratory: Bill to: <br /> r <br /> r <br /> e12/J31 YA: IVm1,— &i/ I I <br /> Distribution: White-Lab,Yellow-File,Pink-Originator Formslcoc 121001.fh9 <br />