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New <br /> 720 Olive Drive, Suite D <br /> .�� Davis, CA 95646 <br /> Lab 530 297 4800r <br /> ANALYTICAL pec Fax 530 297 4808 Lab No 0100 Page f or t <br /> Project Contact(Hardcopy or PDF To) California EDF Report? ❑ Yes ❑No <br /> 05- a f},w74 Challn-of-Custody Record and Analysis Request <br /> Company/Address Reoommendedbut not mandato to can ieiethissection <br /> Sampling Company Log Code Analysis Request <br /> Phone No FAX No Global ID m x <br /> 3S 3ZS 0 351178 o aw <br /> W 00 <br /> co Project Number PO No EDF Deliverable To(Email Address) `S S co <br /> S GC � x o <br /> Project Name // / �^ Sampler Signature _ °-11;0 m a m <br /> r-V c k to�� C__ G �� � ` "' °p w O c� m 0 Q a N o N <br /> Project Address a a N ° .73 0 N <br /> Sampling Co ainer Preservative Matrix N a 1-- P m :3 E 0 <br /> ca 9 N a L <br /> aj W o d Q c c c y mo = N r LL <br /> W M iL Ld y N 0) 0) 01 co N m y N <br /> E W d W z r— w m m c7 <br /> Sample Designation Date Time v z = U z a O M a Q F- Q O O ai a o 5 N <br /> 7 m F F i'- �n 1� in J 111 J r <br /> LA/ - ll-Z6-o 10 q <br /> w - )055 1 <br /> w - <br /> (0 05 <br /> r A 4 <br /> 1 Tq <br /> 010 <br /> rte- 1fi� <br /> pp t__ <br /> Relrnquishe Date Time Received by Remarks <br /> I �^ <br /> Relin by Date Time Received by <br /> Relinquished by Date Time R*pceiveo by Laboratory Bill to <br /> 1 y! �o� /zAn� l GE <br /> Drstnbution White-Lab, Yellow-Fite,Pink-Onginator Formslcoc 121001 M <br />