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2795 2nd Street, Suite 300 <br /> Davis, CA 95616 <br /> ANALYTICAL ccc Lab-, 530.297.4800 <br /> Fax: 530.297.4808 1 <br /> Lab No. 3q I Page of <br /> Projectntact ardcopy,01 PDF To): Califomia EDF Report? i�res ❑No <br /> V K4.,rChain-of-Custody Record and Analysis Request <br /> Company/ ddress: a,�, „ marwatwy to ff* ore <br /> Sampling Company Log Code: Analysis Request <br /> Phone No.: FAX No.: Glob ID <br /> _ ti m x <br /> Ld <br /> Projedlmber: -j5.0, No: EDF Del eral; o(Enroll dd sl: m m o c <br /> 4 t71�7_C.�1 l ('�' 1 �� O W W W N x 3 <br /> cc <br /> Proje Name: �y Sampler Sign to � N m m <br /> / Viaa m a0 .e w O <br /> W m F <br /> Project Address: Sampling Q a � 'a ~ <br /> P 9 Conta a Preservative Matrix �, -- o 1'! <br /> N r m <br /> Q m w m � r in m '� <br /> O W o = O m m m iv C y m R N ❑ <br /> I j n W W ?�( xd ❑ y 9 cc N N m 1L <br /> C1 J , U Z tu O Q W liJ 2 2 x S[ a <br /> Sample Designation Date Time a cn = = U Z o �' r � 4 a � � 0 0 0 � a o W N <br /> m F- � W <br /> -Ig-a 513 ) <br /> 5A t7 A <br /> Relinquished by: It f. , -rate Time Received by: Remarks: A � <br /> Y s 2 / r T <br /> Relinquish y: Dale Time Received by: Tf <br /> 45 <br /> Relinquished by: Date Time Received by Laboratory: ki Bill to: <br /> Distribution: White-Lab, Pink-originator <br /> Farmsiooc 121001_fh9 <br />