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2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> Jrt��JLLab: 530.97.4800 <br /> CAL ccc Fax: 530.297.4808 Lab No. I Page .2 of Z <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑ Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Actress: Recommended but not mandatory tocomplete thissection. H <br /> !� Sampling Company Log Code: <br /> U. Analysis Request <br /> Phone NOQ <br /> FAX No.: Global ID: co <br /> _ <br /> N O O N W !' N <br /> U <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): ° ° m o >+ <br /> Project Name: pie Sign r : wW o W m o �, w 0 Q+ oho t °f <br /> F- CO 2 m = -_ N U m c O n <br /> Project Address: — a o v °� ° J e N r <br /> Sampling tainer Preservative Matrix N o N N LL N M 1� 00 <br /> Q m 0 U) «O f- «NO. N N UO N 0 <br /> N 2 O m N N i9 C > m l0 t U. <br /> 0y W m ° y m a� m v CD(0 2 Q a <br /> W �n W W J X ~ m m U m m r m M !. v N <br /> of U Z U O Q O a as O O oO 0O � Qa o � � <br /> Sample Designation Date Time v cn = z _ z � cn m m r- to r- r. W > <br /> x /I-/0 <br /> S1 . G 4-4 X XI X � - <br /> El <br /> R qui hed Date Time Received by: Remarks: <br /> Z�3 ►y�3 P ee;S ie- Cr ❑- c <br /> Reli ish d by �,� $�pc/-C <br /> P • <br /> Relinqul Date Time Received by Laboratory: Bill to: <br /> Distribution: White-Lab,Yellow-File,Pink-Originator Forms/coc 121001.fh9 <br />