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KI FF O Davi 2nd Street, Suite 300 cfr 4 � � r <br /> Davis , CA 95618 yup I <br /> Analytical etc Lab: 530 .297.4800 SRG # / Lab No. Page of L <br /> Fax: 530 .297. 4802 <br /> Project Contact ( Hardcopy or PDF To ) : California EDF Report? E] Yes ❑ No Chain-of-Custody Record and Analysis Request <br /> Dan Schreiner <br /> Company / Address : Sampling Company Log Code : Analysis Request TAT <br /> 3017 Kilgore Road , Rancho Cordova , CA 95670 ❑ <br /> Phone Number: Global ID : <br /> (916) 861 -0400 T0607700508 12 hr <br /> Fax Number: EDF Deliverable To ( Email Address) : <br /> 916) 861 -0430 dan.schreiner&stantec. com ❑ T <br /> Project #: P. O . #: Bill to: 24 hr O <br /> 211602057 Stantec N <br /> Project Name: Sampler Print Name: <br /> Stockton Charter Way Commingled Plume -J El <br /> tv <br /> Sampler a� /� 0 48hr o <br /> e coLL <br /> co <br /> Project Address : Sampling Container Preservative Matrix W om ❑ <br /> 4407 441 , 508 W Charter Way & o72hr <br /> co <br /> 1444 S Lincoln St m a <br /> ClStockton, CA 95206 < o a w <br /> > a) I Ud w cc <br /> E a'> > N m O =? — m w 2 1 wk <br /> Sample Designation Date Time 44 in iL c7 � _ 2 z ren ¢ 2 m F- <br /> 92033VINF 13 x x x x x G / <br /> 92033VEFF 3 3 `/5 x x x x x 24 hr a <br /> Relinquished b ; Date Time Received by: Remarks: <br /> rx <br /> 4 � <br /> mquished by: Date Time Received hy, <br /> Relinquished by: Date Time Receiveby Laboratory: For Lab Use Only: Sample Receipt <br /> /� / �] Temp °C Initials Date Time Therm . ID # coaan[ P went <br /> Yes / No <br /> Distribution: White - Lab: Pink - Originator <br /> Rev: 052011 <br />