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Ah <br /> 720 Olive Dnve, Suite D <br /> fftANAJL <br /> Davis, CA 95616 <br /> Lab 530 297 4800YTICAL c.ec Fax 530 297 4603 Lab Na "t Page 2— of <br /> Project Manager PhoneY42 <br /> �,, r54 14" Jc - /y 34 Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No H I For Lab <br /> ,Z,-_ 3�-Z Analysis Request Use Only <br /> Project Number P O No Project Name ,,; WET(x) Y <br /> Project Location Sampler Signature o TOTAL(x) 3 <br /> M m <br /> Y; H <br /> W u7 to io r <br /> Container Method aa `� `� <br /> Sampling (Type/Amount) Preserved Matrix Co o N % rn z r <br /> _ N M C <br /> V3 m u� v1 rn W <br /> Cj o C7 m <br /> Q [n u3 p 2 ❑ 2 aCi m a=i v <br /> O C7 N <br /> � � N N <br /> P W N N <br /> Sample ff W ; € o i i ¢ Q U <br /> Designation -w -0 Q z o Q � o 0 0 0 N <br /> Date Time v sn � u, r x _ z � m <br /> Relinquished bar Date Time Re b s- Remarks - <br /> �� �--- <br /> Relinquished by Date Time Received by Email address <br /> ❑ doc ❑ xis ❑ b(t ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to <br /> Oistnbution White-Lab, Yellow-He, Pink-Onginator COC fhb(9198) <br />