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K' C C 2795 2nd Street, Suite 300 <br /> r r Davis,CA 95616 ILII '"�7 O <br /> Lab: 530.297.4800 SRG#/Lab No. l / i 5 3 Pae of[ <br /> Analytical LLC g — <br /> y Fax: 530.297.4802 <br /> Project Contact,(Hardcopy or PDF To California EDF Report?c �tJ, ❑yes ° Chain-of-Custody Record and Analysis Request <br /> ompany(Address: /&4 Sampling Company Log Cade: � Analysis Request TAT <br /> Phone# ` C Fax p¢ y Q Global ID: 0 _ ❑ <br /> o m 12 hr <br /> Project#: P.O.#: EDF Deliverable Toi(F�{m'' 'I Ad/r�re^ss): a o ElOc <br /> � 24 hr m <br /> pro t Name: m $ a <br /> I Samp Signat S $ o w N <br /> qJ <br /> Project Address: Sam lin tainor Preservative Matrix o e m (m� w < m w o 48 hr <br /> m .c w w ry .Yg� YS w 0 a of <br /> E ym m U 3 rR ¢ <O w <br /> i <br /> 72 hr <br /> O <br /> o Z w> >° 3 <br /> Sample Desi nation Date Time n. z <br /> wk <br /> �s <br /> Relinquished Date TimeReceiveQ by: Remarks: <br /> 4inqu <br /> h y: atep�++J Time Received by: stl // /'I /(� .� ,�'- CV /C�+a'f�j <br /> /o/ ©( Q9 Bill to: sfe✓er (/ <br /> hed by. DateTime Received by Laboratory: For Lab Use Only: Sample Receipt <br /> OI l BTi(, �1,0(J t ,� �i�t{' Temp°C Initials Date Tlme The".ID# codem P,reem <br /> 9. r L Ig 0 ie /6(p, <br /> T — <br /> Yes / No <br /> l Distribution: White-Lan;Pink-Orgineta <br /> Rev: 051805 <br />