Laserfiche WebLink
I y . <br /> 0 0 • <br /> 720 Olive Drive,Suite D <br /> Jri� FDavis,CA 956,G <br /> Lab:530.297.484©NALYTICAL i.cc Fax:530.297.4803 lab No. 8 Page—/—of <br /> Project Mana . Phone No.: <br /> SL S hA i TLE (G - 3°I - LI 7 O Chain-of-Custody Record and Analysis Request <br /> C ny/Address: FAX No.: r Por Lab <br /> 2LLI-7-6N 5 ov 01 ( 7 Z Analysis Request use Only <br /> Project Number: P.O.No.: Email Address: o x <br /> _ <br /> t I L( <br /> q a �f—�f! !�J f 3(�r EI-Pgf ❑.xis Cl.doe Do#Tr `O <br /> Project Name/Location: S r Signature: o o x g h <br /> L4-1Lf5 oG nof1 $ 11 0 0 �_ a� �� � � � � <br /> r <br /> _ m (L <br /> Container Methodw $ ED <br /> n t E t E <br /> Sampll ng (Type/Amount) Preserved Matrix m x x <br /> J 0 <br /> _ _ <br /> 0 <br /> C� C � Y N a O Y <br /> m a W 71 ry m ^ ' <br /> P <br /> Sam le �, LU X m r . . M . <br /> Designation u ° o a _ _ o a q L rCY <br /> Date Time N r r z m t- ti w N <br /> vJ -1'LZ —Mw3 m4H-`4 <br /> siqj 3 K <br /> ,t{; <br /> Lo ZZ — t'1 WT- -110 <br /> U- i' 2 21 - M'd y 5-1101 -04 <br /> v+--'uJ 1 I24r-® "4 -0!5 <br /> Y*A w I III-Iqfro e <br /> WOO -o <br /> Re' q 'shed by: Date Time Received by: Remarks: <br /> 12[A-710. to:n JtM <br /> Relinquished by: Date Time Received by: <br /> Relinquished by: pate Time eceiv y Laboratory <br /> : <br /> Sill to: <br /> OD Imo ! tv Vla Y�r ]L <br /> t,lJ <br /> disUftlion: White-Lab. Yellow•Fde,Pink-Originator coc.ths(5=) <br />