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3050 Industrial Blvd. <br /> ` \/\/a I lace Ku h I West Sacramento,CA 95691 — — <br /> Tel:916.372.1434 Lab No. ((�[) 6 t 3 Page of <br /> s a s s a c i n r s s i n c Fax:916.372.2565 <br /> Project Contact(Hardcopy or PDF To); California EDF Report? 11 Yes No Chain-of-Custody Record and Analysis Request <br /> Ben McLernon <br /> Company l Address: . mended but not nnendemry to complete tbi.semen: Analysis Request ~ <br /> Sampling Company Log Code: H <br /> see above 12Hr <br /> &h� 7e No.: Fax No.: Global to: m 0 <br /> "�.- g 24 Hr <br /> Project Number: P.O.No.: EDF Deliverable To(Email Address): o t Q >. <br /> 5279.03 bmclernon Wallace-kuhl.com v 48Hr o <br /> Project Name: Sampler a aN <br /> Turner Road Vintners Signature: 72 Hr <br /> Project Address: 5arnp Ing I Container PreServatIve a fix R p <br /> m V f <br /> tiJ <br /> o c a' WK c <br /> Lodi Q 0 'z y o <br /> O E 2 U u. <br /> Sample E w a E m O z m w c OK <br /> Designation Date Time v 0 d h ¢ i i 4 z 3 m z r c rm7 w <br /> MW1 lid 21 1 x I 1XIxxxxx 5Day <br /> MW2 f yq 1 21 1 x 1XI I x x x I x x 5 Day <br /> MW3 3//6%/0 8�5a 2 x x I I x x x x x 5 Day <br /> MW4 X/ 7� z x x I I xxxxx 5Day <br /> MW5 fool z x X1 I x x x x x 1 15 Day <br /> Relinquished by: Date Time Received by: Remarks: <br /> Relinquished by: Date Time Received by: <br /> 7e <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> �d;iZ z40f -/o /A:G <br />