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r <br /> 720 Olive Drive,Suite D <br /> Jr <br /> t <br /> Davis,CA 95818lab 530 297 48p0 <br /> ALYTICAL LLC Fax 530 297 4803 Lab NoPage of <br /> Protect Manager r Phone No <br /> t/VA— 6kei - I ` q,,V -oi z3 Chain-of-Custody Record and Analysis Request <br /> Com an (Addressi-t uN .�� C FAX No For Lab <br /> 4 �J 04 toIte 4 Aec-:�� &'L' 416 �56 <br /> Ic } 'S�Z7'] Analysis Request Use Only <br /> Protect Number PO No Project Name a WET (X) Y <br /> to °o TOTAL(X) <br /> Project location ) Sampler Signature <br /> 0 CUJ a <br /> in Q N _vl L <br /> ontainer Method c z X 0 - <br /> Sampling (Type/Amount) Preserved Matrix N o a .. <br /> lz ONO V 0) L <br /> {q) J p y w0 <br /> ¢ w -+ N p = G C C O O N Z <br /> Sample EWA o Z �SssQ � � � <br /> o � .0 o z W 0 ¢ a a 0 0 0 0 a a a <br /> Designation Date Time Nt N v, r z v z m ao w r +n r• ,. w w a <br /> til <br /> sJ <br /> Relinquished by Date Time Received by Remarks <br /> 5C,Sh0i 1k Q <br /> Relinquished by Date Time Received by Email address <br /> "- — -- _ ❑ doc 0 A ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bili to <br /> � n <br /> Distribution White-Lab Yellow-Fite Pink-Ongrnator coc fhb(9198) <br />