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720 Olive Drive, Suite D <br /> .�� Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL cec Fax 530 297 4803 Lab No Z Page-L—of <br /> Project Manager e PharNo <br /> L v h Chain-of-Custody Record and Analysis Request <br /> CompanylAddress FAX No f- For Lab <br /> n sis Request Use Only <br /> iF <br /> Project Number PO No Email Address <br /> CID0 m Cto <br /> N <br /> LIpdf ED As EIdoc LJ other o � m w > <br /> � <br /> Protect Name[Location C S J Sampler Signature X °X�X o x I^ N m ,� <br /> �I n m o w W w m <br /> -�Crz v`� ryo n r- r ¢ s <br /> m m m m m w p o o `o `o `o <br /> Container Method W m m ¢ ry s E E E E <br /> Sampling (Type/Amount) Preserved Matrix a a N Q N r T r <br /> J_ _ w 0 <br /> N in Ol tll l.L N <br /> 0 0° 0 m S .61. �' ro s - <br /> Q N ro ro ro C t3t44 � @ N L w "m w m m <br /> Q w tY pOp Q N N 41 V _ V 2' <br /> > > es W 11.1 {yw, m m (7 rn m rn }� ?� n N n u rr a ri <br /> Sample E J v o w o Q r Q a 0 0 0 0 N <br /> Designation Date Time ot U _ z m m 3 <br /> 1U�1'1 ,� -6017/ <br /> /vi �J..�e L�L ray I <br /> 152-7 v <br /> -�`' <br /> MVJ - ! 13Gly 7 <br /> V �ti- 1Er r <br /> �og <br /> Relinquished by Date Time Received by Remarks <br /> Relfriquished by Date Time Received by <br /> I <br /> Relinquished by Date Time Received by Laboratory �'�� BIII to <br /> t1 1 <br /> COC fhb(5100) <br /> Distribution White-Lab Yellow-File Pink-ongrnator <br />