Laserfiche WebLink
720 Olive ©rive. Suite D VA V b 1 t e 'TO #A Q r kos 'r Dic, <br />Davis, CA 95616 % S G I Y o 4t ki 4 t P C k`t it k% ID r, *100 <br />+�i GA J5 4 <br />Lab: 530.247.48405Q Gt^Q ►t' Cl j e 2 <br />� � � `� � <br />Fax: 530.297.4803 � 9 � (3� �'� � '" ifl � �S; Lab No. Page of <br />Project manager: <br />Phone No.: <br />_ s <br />Chain -of -Custody ecord and Analysis Request <br />a <br />Company/Address: <br />FAX No.: <br />E- <br />For Lab <br />R -t m a E Kv r' -r o st %m t% LZ <br />(,916) 3 S 4 l <br />Analysis <br />Request <br />Use only <br />Project Numb: P.O.:�10_: <br />Project Name: <br />�, kD: � <br />ti�.E_T. ixl <br />Y <br />- <br />TOTFl. K A <br />- ___. i-- <br />I <br />Project Location: <br />__ <br />Sampler Signature: <br />'^foS'eviitce ilkV tt �` [a.. <br />N i 4A <br />Z; <br />EU co M a <br />r <br />Container <br />Method <br />Sampling <br />(Typelknouat) <br />Preserved <br />Matrix <br />4q 07- <br />a w <br />z <br />«J <br />70 qy 0 <br />M <br />P <br />w : r- aSample ri <br />CO i CD <br />v <br />E <br />U <br />0 <br />c, <br />� <br />z <br />�, <br />® <br />a <br />� z(L c� o a <br />�� <br />N <br />es 1 nation <br />Date <br />'Gime <br />� <br />� <br />,� <br />s <br />= <br />� <br />z <br />� <br />� � '- r, � �, � <br />� u, J 0 <br />T.3 -- <br />1 tgs�9 <br />200 <br />K <br />X <br />S <br />X <br />-- <br />X <br />a <br />X <br />Jt <br />5 <br />X <br />X <br />x <br />n z <br />..�..3 W -- 6G <br />210 <br />X <br />T1 v, JG <br />2-5,0X <br />_ <br />X <br />X <br />X <br />-mit <br />T i w -- t c <br />%35' <br />X <br />x <br />S- <br />x <br />X <br />-� <br />. <br />NW-- 3 <br />X <br />-- <br />X <br />S <br />K <br />X <br />p -• M L - <br />-• <br />-- <br />- <br />— <br />- <br />- <br />D- SW -3 <br />310 <br />� <br />X <br />— <br />X <br />� <br />�- <br />� <br />r� �l <br />Retnquished 1 by: <br />Date <br />Time <br />Received bef: <br />Remarks: RIt V i^ t- 'tb : gR� ct m r -r l t> l:A v i Y{� k W! t' h i l <br />40 A <br />linquished I by: <br />ate <br />Time. <br />Received by: <br />Email address: t'c{ 1vi ct f Gni l w e <br />[—Relinqufsh--d <br />❑.doc Uxts .txt other— <br />? by:�� - <br />ale <br />Time <br />Receivpd by Labofalory: <br />Bill 10: j , $ t 1y 0 V .e- <br />ct�c ma hiss <br />T <br />� <br />B <br />m <br />ry <br />C� o <br />Cid <br />X <br />a7 sa <br />v <br />ID <br />N3 <br />cn <br />CD <br />v <br />m <br />1 <br />3 <br />-rI <br />x <br />z w <br />®� <br />w <br />CD <br />CD <br />w <br />D:slabadion: WA_9,te- Lab, YeiloN-Fib, Pink-Urigina-, � �N <br />