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720 Olive Drive, Suite D <br /> .�� Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL ccc Fax 530 297 4803 Lab No '2AO'LA Page—L—of >� <br /> Project Manager Phone No <br /> ")oE n X16 3 541- 3,Z 3'V Chain-of-Custody Record and Analysis Request <br /> Company/Address Pa 13d>t g-69 FAX No <br /> �/� -Ch© /ye' Sy ?e6 Analysis Request a <br /> F <br /> Project Number PO No Email Address m x <br /> _ o <br /> ❑ pdf E) As ❑ doc ❑other w <br /> Project Name Sampler Signature 2 <br /> J I[1L�P �✓ �� T �, m a 1 o <br /> Project Location _ LU LO UJ W o H <br /> 392 d #M&T 81yo 92t '✓lcr sN a H y <br /> EL <br /> Sampling Container Preservative Matrix o P <br /> o` <br /> U, ami w = QU. <br /> Sample W _ wJ x � � � � � N <br /> Designation U Z U UJ a a a o a o o N a O m N <br /> Date Time v vy x = _ z vy m m r � it N I.- Lf) r- LU > J <br /> _02 <br /> 21 <br /> Relinquished by Date Time Received by Remarks <br /> elinquished by Date Time Received by <br /> Relinquished by T� Date Time Received by Laboratory t'�/` Bill to <br /> I'Z?aal <br /> Distribution White-Lab Yellow-File Pink Qnginator Formstcoc 062801 fh9 <br />