Laserfiche WebLink
1046 Olive Drive, Suite 2 Phone# 916-753-9500 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Western Environmental Davis CA 95616 Fax# 916-753-6091 <br /> Science&Technology Sample Receiving# 916-757-0920 <br /> Project Manager Phone# c <br /> C y l For <br /> K'f 14 - of Z3 ANALYSIS REQUEST Lab <br /> E T (,411 Use <br /> Company/Address FAX# ( / ONLY <br /> .� L}� m OTAL(V4 <br /> Protect Number P O# Protect Name (o N <br /> � <br /> O Y <br /> k7 r-Do --ger 1. 4elk-f <br /> Protect Location Sampler Signature , = <br /> N <br /> _113 y�, ]� , �-��r y�7 Lao, G► �,(/�., c o 2 -P m t z <br /> v Co <br /> Sampling Container Method i x Q c; v o 0 0 0 0 o ro v c <br /> p (Type/Amount) Preserved Ma rl ro ,� ° "' °° °° ^ m C N bo <br /> Sample ID a a � od0 NN2o <br /> U) P r� 11J � `D a w In o 0 0 Nr ni r 0 a <br /> DATE TIME ¢ w g `� o z rw- J `° '° `° `° '° `° `° o U ° <br /> O Lu ca Uz O ¢ p u� = s ¢ ¢ ¢ ¢ a � t <br /> a {) F 0. a a a a a ¢ C <br /> T J = _ — z U7 m in t- F- W w w W W U ..J U <br /> 7q./0 <br /> M W, Jt I t9 �C aZ <br /> a) <br /> 5-ia� uJJJ f6 ►� I - _ �- �`F <br /> L I-1-11 1 i <br /> Relinquished by Date TimeR ceived by Remarks <br /> 61 1�,OD� 3LL- t/"��f� `� L <br /> QIAJC V. A� C�fI��1{LF'T.�OfZ,3 <br /> 1 <br /> �yl <br /> R uishedby D to Time Received by JC— '4't'l I" 0Y &r,TV; 'DIPS <br /> o(.r MTBG MS(3 G��� <br /> Relinquished by Date Time Recei ed by Laboratory Bill ToAdk <br /> `pL <br />