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1135 W.Sunset Slud,Unit A <br /> Excelchein Rocklin,CA. 95765 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Environmental Labs Ph:916-543-4445 Fx:916-543-4449 <br /> Project Manager: <br /> S :,�- EleC.c�tfIoGnitcI Data <br /> a CD�e{�livi�era. b! u�es_ Lot��� Qu <br /> C 'Em�dd� "s: <br /> Company/Address:CAu RT-c.�C✓1-�.E-' Fax#. E� v �CQ `VCQ } Q.`cQ � 17 <br /> Q 4oas 1 � � S�� <br /> S — ANALYSIS REQUEST __-- Page_of <br /> Project Number/P.O#: Project Name: Wet <br /> co (O N V <br /> Total „� V) <br /> Project Location: S mpler ig to o o <br /> C uvQl co Lo E M <br /> D( IkI <br /> t 0�Nv0t n a <br /> Sampling Container Method o <br /> Matrix r-- <br /> 0 <br /> ad <br /> Preserved oo 1 <br /> w C m Eo QSanpl@ o <br /> Cocli <br /> @ <br /> ® Date Time o ® 75 <br /> O> rU) uy w <br /> zLu <br /> O a CrO a wQa — Um a OU > M <br /> +IH3 22 <br /> LT- , <br /> � <br /> ' ZC <br /> M& <br /> .......... <br /> Relin wished by: Date Time Received by: Remarks/Condition of Sample: <br /> Relinquished by: Date Time Received by Laboratory: <br /> S!I!To: <br />