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• b • <br /> w 720 Olive Drive, Suite D <br /> 1fiAJNVA <br /> � °oDavis,CA 95fiifi <br /> L ab:530,297.4800 GLYTJ 2 AL pec Fax:530.297.4803 Lab No. Page J -,f-!,- <br /> Project Contact(Hardayy or PDF To): EDF Report? FA Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Carnpany Address: Waoomnerded not a res„dlaL <br /> tp< NL Sampling Company Log Code: _ Anglysis Request <br /> Phone No.: a, FAX No.: I Global ID: <br /> m V <br /> - W <br /> Project Number: III P.O.No: EDr Deliverable To(Email Address): <br /> Project Address: Sampler Signature: T.r.�i/ate,` o m m 0- r <br /> w "' n in <br /> Pro'ect Name: s - ° m o N <br /> O Sampling Container Preservative Matrix _ o N <br /> W <br /> m �co c n' <br /> co <br /> L. <br /> o W O <br /> Ui <br /> W <br /> 0 Sample zW O mD@SInation D0. a ° o 0 oDate Time v a w <br /> > m <br /> M42-1 lel -1 lits 1( )C )r x <br /> r <br /> °-L -3•y X K rT t <br /> o /:vr k k X s3 <br /> e <br /> r" <br /> yr-oL �.�� X X GS <br /> A Q� <br /> M <br /> x !, <br /> M K <br /> a <br /> 9 <br /> o <br /> Relinquished by: ill Date Time Received by: <br /> Remarks: 1` <br /> Relinquishe q Date Time Rom by: <br /> I ® <br /> Relinquished by: Date Tune Received by Laboratory. Jr Bill to: <br /> 9- <br /> Sztrt q,� G� <br /> Disfnbutian: While-Lab, Yellow-FiJe,Pink-Originator Fonna/coc 121001A9 <br /> I <br />