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2795 2nd Street, Suite 300 <br /> IrtjT <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> TICAL ccc Fax: 530.297.4808 Lab No. Page 01 <br /> Pro' ct Contact iiardcapy ar PDF To): California EDF Report? Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Co pang/Address: Ibeoonnlerded6utnot to yi n; <br /> n�`f sampling Company Loy code: Analysis Request <br /> Cf I <br /> Phone No. � Ei�� r Z Global 10: m X <br /> •0 T -0 .Z m m <br /> to 9 _ w <br /> Project Number: P.O- No: ED D ble To mall Addr ss�: m N m m � <br /> 13 8 <br /> N 2 <br /> � � N <br /> Proje Name: Sampler Signature: , - <br /> • �n $ w c w a <br /> 0 <br /> Project A re Sampling Co i er Pr ervative Matrix a �, ­ <br /> 03 <br /> �ZI <br /> • 7•\� ¢ C} N O m 0 m .m. .... v <br /> 0 W m == O m C G m y Om = N L U <br /> We+i W ` m W ,�I Ol 01 ��` N y, <br /> Sample Designation Date Time 0* � _ = c0 LU <br /> z � w m � r F � U5 ° O � J CL <br /> a <br /> V�S— N F -Z- firs X o z <br /> Relinquished by; p+t D e Time Received by: Remarks: <br /> �o(-i vq 1315 r7-&4-4a <br /> Relinquish t <br /> d y: Date Time Race-Ned by: <br /> 7 <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> Oistributian:'• -Leh, Pink-Originator :```; r:i•.:. 51coc 121001.th9 <br /> s <br />