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720 Olive Drive,Suite D <br /> .�� Davis,CA 95616 <br /> Lab:530.297.4800 <br /> ANALYTICAL uc Fax:530.297.4803 Lab No. a--� Page of� <br /> Project Mana r. <br /> PhO ?6 'L/ 7v Chain-of-Custody Record and Analysis Request <br /> Com yi'Address: FAX No.: <br /> r-J For Lab <br /> /Z./Z'a..! rJJJ Analysis Request use ordy <br /> P i Nurr>ber. P.O.No.: Email Address: m x r <br /> (� n ` d m Gl N ►^ 3 � � v a <br /> r yf 4 7"[`13 (i ❑.pdf ❑.%Is ❑.doC ❑Other 6 <br /> Project Name/Loca M: I Samp r Signature: °D m Q m <br /> f0� a jZ <br /> N N Q S S <br /> m $ o- fi <br /> Container Method m m 3 m °6 — �' n e E E <br /> Sampiing (Type/Amunt) Preserved Matrix r =a _ = a a a <br /> J I[ 5 F F b N 7 O! p p G <br /> 40 <br /> iV = m � C > m m L � <br /> W O in C O Q = N C Q lY K cc <br /> SamplP n w M C T u N y N <br /> e xx x a ; YC N �D t 11 Y t! [I [I <br /> W O Z W iil x 2 7C k <br /> Designation Date Time v Vi z x U i m m ►d- r u �r n °� n <br /> W-12 2Z—Mw"L )2- J2;-V <br /> $tad I I _ _oq <br /> 2Z— r lc.� Q.,30 _�o <br /> W—!222.--Mvi <br /> -tom <br /> Jw <br /> Retro i ed by: 41ap <br /> Time Received by: Remarks: <br /> in� ,� iD,S *FA <br /> Relinquished by: Date Time Received by: <br /> Relinquished by: DateTime iv by L ratory: Bill to: <br /> t'5�� 1 0 k-0-4- FW0\\0%AVJ <br /> Distribution: Whir&-Lab, Yellow-I'de,Pin*-Orfginafor COG."(SM) <br />