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720 Olive Drive,Suite D <br /> Davis,CA 95616 <br /> Lab: 530.297.4800 �r <br /> ANALYTICAL LLC Fax:530.297.4803 Lab No. — Page <br /> Project Manager: Phone NO.: <br /> D.. S�� GGA 5 �� Chain-of-Custody Record and Analysis Request <br /> Company/Address: G[/���,,ly FAX No.: N For Lab <br /> 13n d GGL oz73 Analysis Request < Use Only <br /> Project Number: P.O.No.: Email Address: <br /> nn <br /> in to H V 9 U R 9 <br /> ❑.pdt 0.4s; ❑.doc Elother o a 3 <br /> Project Name/Location: G � Sampler Signature: <br /> i6 m ❑ 5 <br /> X <br /> 5- <br /> in� <br /> � 1G G�'¢ Container Method o w A m w <br /> / a0 m a L7 Q N E E E E g <br /> Sampling (TypelAmount) Preserved Matrix r z = N d s` I^ a a a Q <br /> ❑ <br /> p m 2 i4 A � _ C4 ~ <br /> le W W m n 8 <br /> Sam N n a <br /> Designationw v c�i O ¢ a s o 0 a Q N <br /> C L <br /> Date Time Y z m m A N A > Q <br /> /S S <br /> Z.4 -5 _R_ -13 <br /> o - --- --1 <br /> 1131 ?Y. <br /> 2411 LX <br /> k, <br /> Relinquished by: Date Time Received by: Remarks: <br /> Retinquishe ' D le Time Received by: <br /> Relinquished by: Date Time R pived by Laboratory- T <br /> to: <br /> Distribution: White-Lab, Yellow-F4e.Pink-Origmefor COC.th6(5100) <br />