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720 Olive Drive, Suite D <br />Davis, CA 95616 <br />IftAJNA <br />Lab: 530.297.4800 <br />LLC Fax: 530.297.4803 Lab No. ► 2 77Z t;' Page of <br />Project Manager- <br />1--7 0, Y- LJ 7Ba k:1, Q C <br />Phone No.: <br />P16 __<34�2 -Z/;7C,) <br />Chain -of -Custody Record and Analysis Request <br />Company/A ress: <br />FAX No.: <br />t— <br />For Lab <br />Analysis Request <br />use Only <br />Proje umber: <br />P.O. No.: <br />Pro'ect Name: <br />W.E.T. (X)C4 <br />x <br />® � <br />5 C <br />2 <br />cli <br />3 <br />/ ' <br />� <br />N <br />� <br />i <br />� <br />TOTAL (X) <br />`�,. <br />Y <br />3 <br />Project Location: <br />Sa pier ature: <br />/� <br />' (/'t <br />o <br />m <br />m <br />Jge174 2i cl <br />ja <br />E) <br />�_� <br />Co fine <br />Method <br />Sampling <br />(Type/Amount) <br />Preserved <br />Matrix <br />N <br />- <br />g <br />o <br />0. <br />0-% <br />N <br />w <br />Z\ <br />L <br />N <br />N <br />o <br />d <br />N2®g <br />M <br />NC <br />CD <br />J <br />O <br />O <br />Q <br />2 <br />C <br />C <br />O� <br />CO <br />W <br />C <br />Ol <br />O <br />O <br />od <br />a <br />4 <br />N <br />Sample <br />� <br />W <br />c� <br />E <br />O <br />W <br />Z <br />W <br />�- <br />lN0 <br />l0 <br />s< <br />x <br />C <br />Designation <br />Dat@ <br />T'me <br />z= <br />0 <br />Z <br />m <br />_= <br />o <br />O <br />O <br />O <br />Q <br />W <br />Q <br />W <br />J <br />U <br />�` <br />r <br />v <br />r$ <br />- 2_/l,%- /-_ -7 JZ <br />j;3-0 <br />—1-5 /3' <br />3 :35 <br />Is <br />I <br />)--!"3' <br />7)—/--3 a <br />, <br />�- -j \/V <br />Ij` <br />�l <br />X <br />I <br />c, -7 <br />R linqu' by: <br />Date <br />Time <br />Received by: <br />Remarks: <br />'Reli'nVoh6d K. <br />Date <br />Time <br />Received by: <br />Email address: <br />❑.doc Elms D.txt Elother <br />Relinquished by: <br />Date <br />Time <br />Received by Laboratory: <br />Bill to: <br />//-/;;- 'V <br />C2ctl <br />-X ,( ly-L, <br />Distribution: White - Lab. Yellow - File, Pink - Originator <br />COCA8 (9/98) <br />