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720 Olive Drive, Suite D 'Row -Row <br /> Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL 4,Lc Fax 530 297 4803 Lab No 2-32-351 Page—t—of <br /> Project Manager Phone No <br /> J O 3 S y 3 2-S0 Chain-of-Custody Record and Analysis Request <br /> Company/Address Pp �X � FAX Na <br /> t �� Analysts Request <br /> ►ic o J �8 / a <br /> Project NumberP O No Email Address m x <br /> ❑ pdf ❑ xis ❑ doc ❑other h $ 0 N W <br /> Protect Name Sampler gnature 2 ° ? <br /> yy(( xx <br /> T r o lU W <br /> go S G <br /> m m a m <br /> Project Location �, w Q w ° r <br /> o Tom' SGC m 04 N <br /> d d N � d J CC fV L {d <br /> N L ` <br /> Sampling Container Preservative Matrix m ; a H t` N v <br /> U' m O F e�yp y Ln O N C <br /> 0 W O = 0 r2 m C C C W } ca O T N L LL <br /> Sample o � z � 0 Qo L = = = o 000 � a <br /> Designation Date Time v W z = U z (n m m Ln r- W r- w r <br /> w '1 l)• -02. <br /> 3 -03 <br /> -Dy <br /> s117 1 -05 <br /> 44 �. <br /> r2' -D7 <br /> V w L.24 -�9 <br /> Relinquished b Date Time Received by Remarks <br /> 'r <br /> Relinqui Date Time Received by <br /> Relinquished by Date Time Received by Laboratory �%r tC/- l3tll to <br /> ' 1l 0 6 0/ t65 b OS.auswm�j�i��,(,�,J Jor � G <br /> Drstnbution White-Lab, Yellow-File Pink-Onginator Formslcoc 062801 fh9 <br />