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Exicelchem 500 Giuseppe Court, Suite 3 <br />€icseviIle, CA 95678 CHAIN -OF -CUSTODY RECORD AND ANALYSIS REQUEST <br />Environmental Labs Ph: 916-773-3664 Fx: 916-773-4784 <br />Project manager: Phone: Electronic Data Deliverables Request: <br />i Global I.D.#: Email Address: <br />�d a ca a COC #: <br />Company/Address: Fax S: Location I.D.#: <br />ANALYSIS REQUEST Pae -Z Of <br />CD <br />Project Number/P.0#: Project Name: Wet Bla <br />c m Total N Due Oahe: <br />Project Location: Sampler Signature: C <br />v m <br />__ S m _ <br />�5 Method � Matrix ESampling Container Preserved N ®V <br />a� <br />s <br />tp �' G J z N <br />Sample m LL r5 <br />ID Date Time W o = m �—� a >' <br />> <br />�1 w w w x g }a `'' m U S� o 'E � a LAB USE <br />i W V p Z w O a 0 a y <C v o <br />bJi r a x x U z rn a m [- r- h a a> an I cn V V ¢ ONLY: <br />L t=Y 5 <br />IN I I 1 1 W <br />s Ji ZL rSZs <br />ri3a <br />�`�-syr- tg/ZZ, ISYp -' tloriz-�"S1 <br />6 `—( tojz� ttf2A stvtfiS"i� <br />T i--( tofu 01 <br />7 <br />FIE I I LL <br />i <br />7 <br />7 <br />i <br />l <br />Relinquished by: Date Time Received by: Remarks/Condition of Sample: <br />7 <br />Relinquished by: Date Time Received by: <br />Relinquished by: Date Time Received by Laboratory: BIN T : <br />