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2795 2nd Street, Suite 300 <br /> ,�� Davis, CA 95616 <br /> Lab: 530.297.4800 <br /> ZVA�4-2 <br /> a <br /> Project Contact(Hardcopy or PDF to): Lab No. Page of <br /> EDF Report? <br /> R.Smith ®YesEi,,(, <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Address: Rocammanded but not mandatory to complete IN s-alon: <br /> HORIZON Sampling Company Log Code: DEIO Analysis Request <br /> Phone No.: FAX No.: Global ID: T0607700492 <br /> 939-2170 939-2172 <br /> Project Number: P.O. L4 <br /> No.: EDF Deliverable to(Email Address): <br /> 3641 Stockton 3641-106 rsmith@horizonenvironmental.net 2% <br /> Project Name: Beacon Project Address: <br /> Stockton <br /> Sampler Signature(below): W. 01 <br /> —Project Address: <br /> Sampf ng <br /> Container Pressrvative Matrix two Cli <br /> 3: <br /> LL <br /> W Ili LU m mrn <br /> W S X <br /> 'Kmple Des 0 z to r� Ln 6 0' <br /> Z Desi Date Time 04 C-AJ 12 <br /> MIA, <br /> Mw -63- <br /> 14V— Ing <br /> CA <br /> Relinquished by: Date Time Received by: Remarks: <br /> Reflnqul h Date 'rime Rgoaygd hX, <br /> A <br /> Relinquished by: Date Time R ;elved by Labor;ry: Bill to: <br /> I L) A& I lei <br /> X031 -J <br /> Formstwe 121001-fh9 <br /> Distribution: White-Lab. Pink-Originator <br />