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11M = M = M M = wM = M M M M r <br /> ar <br /> 720 Olive Drive, Suite D Iqw <br /> ffiv <br /> � Davis, CA 95616 <br /> Lab 530 297 4800YTICAL LLC Fax 530 297 4803 Lab No Page of <br /> Prot ct Manager Phone No <br /> L,;• i '66 �� sr 5 �2 3 Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No f- For Lab <br /> IA)t 1) 4 Ce _ �/„� j ,nSlac 312- - _5" Analysis Request F Use only <br /> Protect Number P O No Project Name ,r, o o WET (X) <br /> Protect Location Sampler Signature o TOTAL(X) <br /> 0 <br /> co m (n <br /> Container Method vM cD 0 0 0 9! <br /> Sampling (TypelAmount) Preserved Matrix a o a a (V N z <br /> co coO <br /> Q N fn _ d O m c0O O N t <br /> 03 ❑ 40 N 0 NAW N N n a � <br /> Sample :5 E Q z ' X X co w 'Ya U N_ <br /> Designation Date Time v to _ z Q m F o 0 0 0 J N <br /> i'v1 z�3 <br /> Mwq I <br /> M W �5- r <br /> nn W� 9 -0(�' <br /> new <br /> —t—J —0'7 <br /> Relinqu h y D to Time Receiy ed by C� Remarks �--J <br /> .� CJ�I`l` <br /> h I-JL 1 T Uw r S <br /> Relinquished by Date Time Received by Email address <br /> ❑ doc ❑ xls ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to <br /> Distnbution Whyte-Lab Yellow-Pi1e Pink-Ongmator COC th8(9198) G/y <br /> 1,-GC <br />