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1046 Clive Drive, Suite 3 916 753 9500 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST ` <br /> Weslerr,£nvironmeq:a! Davis, CA 95616 FAX# 916 753 6091 <br /> science a Technology LAB# 916 757-4650 <br /> Project Manager Phone# <br /> ANALYSIS REQUEST TAT <br /> r� 0 — <br /> Company/Address FAX# I Tffm 1 _ <br /> TOTAL(✓) Y <br /> 65,5 <br /> Project[Number P O # Project Name CO U: T z o <br /> v <br /> U - � � ro � o <br /> Project Location Sampler Signature m m L r m P � `o v W <br /> o ,n N b L W W <br /> N 0 U .}'- C N V U <br /> C Q <br /> to CC N N y +�.' Ri r <br /> N W iY Ir <br /> Method opo � m a s ° 2 (L Z n n <br /> Sampling Container Matrix N m � 0 0 0 0 6 0 0 ¢ O � y a C > <br /> Sample Preserved � 0 Z> 8 N (' J " - o N � � � <br /> _ ,8 _ w w co m '4 CO U y O N W � <br /> ID > N H N O O O O r O O N N z r a r` <br /> DATE TIME ¢ Q a p z tu x O _ ¢ ¢ ¢ ¢ ¢ ¢ ¢ Q v V) a Z <br /> p -A Ld � a U z U 0 ¢ Q Fw � � o o cn a a a a a n a. Oc m ¢ a W ei � x Fa- <br /> > N JS S Z (1) m m 0) W F- F- W i W W W W O CEU W J {� W to <br /> m Do <br /> a-5 3 <br /> { <br /> Relinquished by Date Time Received by Remarks <br /> f � <br /> Relinquished by ate Jime Received by <br /> Relinquished by Date Time R ived by L bor t ry Bill To <br /> �--�-- <br /> 10 to 1S IV � <br />