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Excelc 50 iuseppe Lou Suite <br /> Roseville CA 95678 CO-OF-CUSTODY RECORD AND ANALYSIS REQUE <br /> Environmental Labs Ph 916-773-3664 Fx 916-7734784 <br /> Protect Manager Phone#/V6 Electronic Data Dejlverablesequest <br /> Global I D # 1 D G o 7� Email Address <br /> Company/Addres Fax# /& Location I D # <br /> y -/ ANALYSIS REQUEST Pae I of <br /> Project Number/ O# G Protect Name ci°o Wet Bin# <br /> �J Y� ;19 A <br /> � LL <br /> C tC eta e o o Total 14- Due Date <br /> Pro1ec�Loc�tton �p b-ct 5 Sampler S+gnat�+re o 0 <br /> T o�d� („ N L <br /> T m <br /> w y <br /> 00 W p V <br /> C O 1v CCS I Tp n U t <br /> W <br /> Sampling Container Method Matrix 10 E U) m o U a t <br /> ¢ <br /> Preserved 0 0 E a� o a 0 m ❑ N � r <br /> Q Q <br /> N W N co O N J Z <br /> Sample M0 W - 0S CO � _ CLCn <br /> N <br /> ID _ <br /> Date Time W Q c� a a <br /> ry w W W O J- m u) r y <br /> O < U zIII U) <br /> o w 0 a O m H a a o LAB USE <br /> � Y) o- _ z U z 0 ¢ m :E 1,- a a 7 -J cn 0 -J 0 Cr ONLY <br /> Reli lshe y Date Time Received by Remarks/Condition of S//amp !! <br /> WJ4 41141 <br /> elinquished by Date Time Received by ��k T <br /> Relinquished by Date Time Recei d by Laboratory Bill To <br />