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t.r.i <br />AIFAV 720 Olive Drive, Suite D <br />Davis, CA 95616 <br />AN I&HOW Lab: 530.297.4800 <br />ANALYTICAL LLC Fax: 530.297.4803 Lab No. ���/ � Page /of <br />ProjeManager: <br />rr- <br />Phone No.: <br />)14! - �_3 9 - z/ 70 <br />Chain -of -Custody Record and Analysis Request <br />Compan /A ress, t <br />,� . ► l 5 <br />FAX No.: <br />-- Zl -7 z-- <br />Analysis Request <br />H <br />For Lab <br />use only <br />Project Number: <br />/ <br />P.O. No.: <br />Project Name: <br />w �L <br />m <br />g <br />t0 <br />~ <br />m <br />�' <br />� <br />z <br />C^ <br />2 <br />o <br />s. <br />_ <br />a <br />� <br />o <br />c� <br />_ <br />a <br />of <br />n <br />v <br />rn <br />St <br />o <br />v <br />si <br />o <br />N <br />Q <br />W <br />N <br />Go <br />W <br />W.E.T. (x) <br />N <br />t <br />N <br />�v <br />TOTAL (X) <br />Project ocation: <br />►1 <br />Sa pier S' ature: <br />M <br />J <br />z <br />C <br />Sample <br />Designation <br />Sampling <br />Co fain <br />(Type/Amount) <br />Method <br />Preserved <br />Matrixy <br />®ate <br />Tame <br />ff <br />� <br />W <br />N <br />W <br />__ <br />o <br />9 <br />z <br />Z <br />_J <br />3 <br />% - Z -- 5 --/ <br />ltd <br />t'/ <br />'X <br />° I <br />-04 <br />�''— -- -S -- <br />Rel quishe <br />/ Date <br />Time <br />Received by: <br />Remarks: <br />inq ' ed by: <br />Email address: <br />❑ .doc ❑ .xis ❑ .txt ❑ other <br />Relinquished by: <br />4patv <br />)qV <br />Time <br />1601 <br />ived by Laborato <br />Bill to: <br />Distribution: White - Lab, Yellow - File, Pink - Originator <br />CDC." (9/98) <br />I <br />