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2795 2nd Street, Suite 300 <br /> .�� Davis,CA 95616 <br /> Lab: 530.297.4800 [�j r <br /> ANALYTlCAi icc Fax: 530.297.4806 Lab No. q051 Page l or <br /> ProjContact(Hardcopy or To): California EDF.Report? FDYes No <br /> Chain-of-Custody Record and Analysis Request <br /> Comp ny/ dress: Rom..—KWbutnot boom et dilssecdmr <br /> ` Sampling Company Log Code: � <br /> r� -gv�, Analysis Request 4 <br /> Phone No.: F _: GI bol ID: m x <br /> Project Number: P.O. No: EDF Deliverable To(Email Address): Y m g }, <br /> W m o <br /> Project Name: O'f� �•L Sampler Signa tur • �_ o m m r a r <br /> 'L W u] $ f�� g� m a0 W L N <br /> I- = x m CV co U �' C d <br /> Project Address: . a 4 N .k o o N ro <br /> Sampling Contai r Preservative Matrix a �_ t: �, N a c r <br /> Q m <br /> 3 H r °7 v o N J v <br /> �j IL m O n m C C ' c `° N r ILL <br /> E O Z H c <br /> J y( u R W C9 T coo m `' <br /> Sample Designation Date Time v _ _ °z F [Ft-1 a a = 0 0 aC m a o L <br /> m m F Hn 1� U] I.- J LU J J r <br /> 1M f p-s-�iy t�4q ! b S 01 <br /> l b Jess x 0-1- <br /> is iS IS>�o n3 <br /> rv�MW <br /> l.v I - �S Ise s X o 5 <br /> If - 5c) szc 0� <br /> r <br /> - 3S 07 <br /> .W 1 SSSI I& I �C Oq <br /> = 5o 0'sxqC 1 <br /> Relinquished by: >..�� 10�at� _ Time Received by: Remarks: _Q <br /> Relinquished Date Time Received by: Yf <br /> by: Date Time Re�bora'lo, �/f Bill to-- <br /> Relinquished �] <br /> Distribufid' `'';'hrte-t ab, Pink-Originator <br />