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2795 2nd Street,Suite 300 <br /> Lab:Davis,30.97.4800 <br /> Project Contact{Hardcopy or PD tLab No. Page of <br /> � <br /> R. Smith EDF Report?o): R ®Yes ❑No <br /> Company/Address: Chain-of-Custody Record and Analysis Request <br /> Recommended but not mandatory to complete this section: <br /> HORIZON Sampling Company Log Code: I.- <br /> Phone No.: �Ax DE10 Analysis Request a <br /> Global ID; <br /> 939-2170 939-2172 T0607700492 ~ <br /> m V <br /> Project Number: m m <br /> OF Deliverable to(Email Address); <br /> 3641 Stockton 3641_C8 rsmith@horizonenvironmental.net <br /> Project Name: Beacon o N " 3 <br /> Project Address: m <br /> Stockton - � "' m m m a m <br /> u� n o `v, a m w O = <br /> Sampler Signature{below): o co o ¢ N w <br /> Project Address: <br /> Sampling ! n a N a J n Z m <br /> P g Container Preservative Matrix a U) <br /> m `a N to dl m v LL <br /> Q C7 Tin m m e <br /> j m ❑ m c c y s o = n r` U. <br /> "�v E W W m w L Q' a°° y r.0 <br /> d C N <br /> W O W Z H k x <br /> Sa 1e Designation <br /> 7DateTIrre a in z ° Q `p _ z o o o a m N <br /> x s v z vs m m r Ln r` Tin t- w <br /> 6-05 3 a <br /> Da <br /> r D <br /> r�! � Q y <br /> � _ <br /> W - l 2, a=1 <br /> - <br /> /kW- 13 ! �� � 6 <br /> Relinquished b : TT " <br /> Date Time G Y me Received by: Remarks: <br /> Resin TMtnp'C TAsnn.IGle 7'R—'� <br /> Date Time Received by: 11111'" p D l D <br /> Two all OWARt N <br /> Relinquished by. Date Time Received by Laboratory: Bill to: <br /> Ir <br /> ROB F15ffl3cl2n/ <br /> Disfribufion. 7;9-f.ab, Pink-Originsfor <br /> c}�3kc0c 121067.fi9 <br />