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2795 2nd Street,Suite 300 <br /> Davis, CA 95616 <br /> Analytical LLC 0 Lab: 530.297.4800 SRG#I Lab No. <br /> Fax: 530.297.4802 Page of <br /> Project tact(Hardcopy or PDF To): California EDF Report? AYes—E]No <br /> ml <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Address: Sampling Company Log Code: <br /> Q4Mrr%ft Analysis Request TAT <br /> Phone# Fax Global ID: <br /> El <br /> Ln <br /> Z17 6 -170 (o 0 �--4-0 0 " -z— o 12 hr <br /> Project#: 1- 3 -- <br /> P.O. FDF�Pfvprable (Email Address)• 21/ <br /> di 0 <br /> -CIL LU <br /> P 24 hr <br /> Pr Name: z5amp(er signatLim: I 6 NWy <br /> < <br /> CL LU ID C4 <br /> WN co <br /> Project Address: CL ❑ <br /> —J <br /> Samolina Co*din6r I Preservative Matrix co cc e <br /> co 48 <br /> M CL <br /> U. LU hr L0 <br /> m m L <br /> C'40 W W (L ()00 LU 13 4 <br /> 2 UJ 'a 0 S El <br /> ILu X 0 0 0 I - UJ 72 hr <br /> LU LU <br /> Sample Desig z LLJ 2: <br /> nation 0 IL 0 0 -6 a- CL Z <br /> m z ;F( Z <br /> Date Tima 505 flail I I r 421 -1 11 2 6 L! r! ?J > > 1 VA. <br /> 435 �K X /K <br /> 'c' —N:E <br /> 5- -J— --7--o; ima 1 <br /> 7 1 <br /> fwk <br /> Relinquished by. y Date Time Received by. <br /> Remarks: <br /> I <br /> Relinquish T Date Time Received by: <br /> Bill to- LAI I+I. <br /> Relinquished by: Dale me RET by Laboratory- <br /> Ti <br /> For Lab Use Only. Sample Receipt <br /> Temp-C Initials <br /> Date Time Therm.IDN c w w Pram. <br /> Disbtudorr. White-Lab;f4nk-Odginator Yes I No <br /> Rev: 051805 <br /> ------------------------------------—-------- <br />