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r � ■ <br /> 720 Olive Drive, Suite D <br /> AFF Davis, CA 95616AML _ <br /> Lab 530 297 4800 <br /> Contact(Hardcopy or PDF to)` fax 5 to 747 4Af1R <br /> ilii <br /> EDF Report? ®Yes ❑No Lab No Pageof <br /> ,y/Address ttecontntOna"but not mandatory tocompl■tsthlssection Chain-Of-Custody Record and Analysis Request <br /> VZON Sampling Company Log Code DEIO <br /> 40 FAX Na Global ID TOfi077QQ492 Analysis Request H <br /> 170 939-2172 <br /> m x <br /> Number PO No EDF Deliverable to(Email Address) fO '- <br /> N <br /> Stockton 3611-102 rsmith@horizonenvironmental net m m <br /> Name Beacon Protect Address <br /> StocktonT �; m Q o <br /> Signature(below) LU3 m Q w ° t a <br /> a ress o a N a <br /> Sampling Container Preservative Matrix 5i m llQp <br /> O ~ ti O J N -1 <br /> Q m 3 m N fV 7 0) C <br /> G1 N m ~ N m m N c <br /> o O 0 m W N a ro <br /> W a`e c c m x v L tL <br /> ate Desi nation ° z J ° °° N � m c N <br /> Date Time a rJn x z U z ¢ O '� = z x x .� = <br /> 0 0 <br /> y o.yo <br /> _ �2z <br /> Ob <br /> 06 <br /> 61 <br /> -I --- <br /> -or <br /> �-Y oa <br /> shed by Date Ttrrte <br /> Received by to <br /> Remarks <br /> .hed by Dale Time Received by <br /> ,Wed by Dale Ttme - - <br /> Received by Laboratory Bill to <br /> Na �_ � <br /> VVhRe-Lab Yellow-Fde Prnk-O�grnafor �O <br /> Formslcoc 121001 fh9 <br />