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0 <br />v <br />EXC61chem <br />500 Giuseppe Court, Suite 3 <br />Roseville, CA 9%78 <br />CHAIN -OF -CUSTODY RECORD AND ANALYSIS REQUE$"T <br />Environmental Labs <br />Ph:916-773.3664 Fx: 916.773-47& <br />Project Manager: <br />Phone #: <br />Electronic Data Deliverables Request: _ <br />Jo}avi M A r -A W P. S <br />09103411 - 4-7 2 2 <br />Global l.D.#: <br />Email Address: <br />COC #: �r- <br />Location f.D.#: <br />.s" s->aa.SC� c`waaa. <br />C, QO�I <br />Company/Address: <br />civims <br />i 00 l " 3: 11* ST(4-CG T> <br />91te '7;L/4 <br />Sroc f-tivw°r C.n. <br />%1912 <br />.311 <br />ANALYSIS <br />REQUEST <br />Page 3 of <br />Project NUmber/P.O#: <br />Project Name: <br />Wet <br />SAVr� E I <br />STE �R.aw.p <br />SAe4Tt VZ iR.l) <br />LL <br />Fu it WiEt-p IbANA <br />o <br />o Total <br />� o v <br />J --v `^_•y <br />Project L.,ocation: erSignatu <br />o <br />4UNJ6R.$i.Vl�, GP.CD <br />o <br />S Nl tTir p s FLO "Ww *--y eD <br />£ ® .4 <br />Sampling <br />P 9 <br />Container M rix <br />-'� <br />E_ y d < <br />` ` > <br />Preserved <br />o <br />m <br />_ m o y <br />0 m^ o <br />{yam <br />P <br />W <br />N <br />In W W m N a Z <br />t9 +� N m <br />ID <br />= <br />N <br />® (7 N v� psi IL <br />> <br />Date Time <br />w <br />o <br />0 <br />o o °s B <br />m <br />C <br />a z i V z 3¢ <br />m <br />16 11 <br />a w <br />COLU <br />F° O yr tai c� <br />.'F <br />3 i Z 2.4 <br />A; <br />IiaL :. <br />- W2 7 -2:54 <br />e i4 2 3:35 <br />I X, <br />XX'xr <br />to z2 3• <br />.�i�]i. ,_�.. <br />T -A <br />J <br />Relinquished by: <br />Date <br />Time Received by: <br />Remarks/CJonditfan of Sample: <br />n j <br />' 2, f•Zi U...41i�1e,�71 470xa �t � kifw f - <br />Jo 23 a1 <br />lj l i <br />140114 97LC WC-T-2-¢�i- <br />ly linqufsh d by: Date Time R eived by: <br />Relinquished by: <br />Date <br />Time Received by Laboratory: <br />BiN To: <br />