Laserfiche WebLink
720 Olive Drive, Suite D <br /> J(iJV <br /> Davis,CA 95638Lab 530 297 4800 <br /> NALYTICAL ccc Fax 530 297 4803 Lab No 2 Page of� <br /> Project Manager I Phone No <br /> a IRq R C 916) 3 Chain-of-Custody Record and Analysis Request <br /> CompanylAddress FAX No <br /> Aq VI t- E%V i ro h WmW 916 3 5 4 -118 6 Analysis Request <br /> Protect Number PO No Email Address m <br /> c <br /> Elpdf FJAs Eldoe ❑other V' C <br /> Protect Name Sampler Signature ° o N y, <br /> yah Too wiq C041t] Motil)t m Go o <br /> Project Location Go m a o m <br /> 0 <br /> NO E. ttqutfaw Aft Stocotow co m 13 ( o Z6 <br /> — g d d N °° O <br /> Sampling Container Preservative Matrix o r- '~ S N N j J <br /> Q m (a N T `L <br /> 7 ili tr m C G C C O N L LL <br /> Sample i' o z t , "m m m h N <br /> Designation � � � Z L) Q o � � a 4 Q a o 0 o m <br /> g Date Time Ir ua = _ — z cn M m � . I . � iu <br /> MW 3- 4 o It'Z9+01 1400 <br /> M�N >- 45 X X x -oz <br /> Mw ; - E5 X x X <br /> D-I i50a I X x <br /> ��z COMPOSITE 3 - +N • I L A 4 i5os I I <br /> D`3 1TiC I x X <br /> Relinquished by Data Time Received by Remarks <br /> onn-'!k— I — <br /> Relinqu shed by I Date Time Received by <br /> Relinquished by Date Time Received by Laboratory Bill to navy al t �flViftl omt4t1 i <br /> oa/ 19'lls 1'10. 00% 149 1 kaKol�e Mw%ii-tUN GA �5 b t3 <br /> Distnbution White-Lab Yellow-File Pink-Onginator Formslcoc 062801 fh9 <br />