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• s •� p <br /> 720 Olive Drive, Suite D <br /> 1(iJV <br /> Davis,CA 95616 <br /> Lab 530 297 4800 2NALYTICAL eec Fax 530 297 4803 Lab No Page of <br /> Project Contact(Hardcopy or PDF to) EDF Report? ®Yes ❑No <br /> R Smith Chain-of-Custody Record and Analysis Request <br /> Company/Address Recommended but not mandatary to complete thls section Q <br /> HORIZON Sampling Company Log Code DE10 Analysis Request <br /> Phone No FAX No Global ID T0607700492C3 <br /> 939-2170 939-2172 m W <br /> 0 o N uJ <br /> m N N m <br /> Project Number PO NO EDF Deliverable to(Email Address) m m m Xca o �` <br /> rsmith@horizonenvironmental net 0 F w a <br /> 3641 Stockton 3641-29 w p <br /> N m m (o a <br /> 0. <br /> Project Name Beacon Protect Address w W m m to ;� W o r tmn <br /> Stockton o g m 0 0 oCo 1- <br /> N V u, c <br /> Sampler Signature(below) _ y p a _t ? "pc� o ; -e J <br /> u, 8 co <br /> co <br /> m („7 N F N N Q) v v N V 1. <br /> d N m N O O <br /> O N = m o m ro i� io c 00 m N r LL <br /> W 0 0 g N c c c <br /> tY m m c3 W = v <br /> Sa ple w _ o Z -J X ro X m N <br /> Designation o W U Z U O Q O t- a a= x 0 0 0 0 a <br /> Date Time v cn z 2 _ z N m m i- r- �, -J w <br /> -16-0 1 1 3 X >< d t <br /> AA w — I-31 a� <br /> 3 <br /> Mw _ .ot 5 <br /> — <br /> 11 Y5 Q 6 <br /> 3-oil <br /> Relinquished by Date Time Receiveh by Remarks <br /> Relinquished bw Date T eceived by <br /> Relinquished by Date Time 7ceive byyLaboratoryBill tofCSL A?. r 6 L <br /> Distnbutron While Lab Yellow File Pink-Ong+nafor Formslcoc 121001 M <br />