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M I]Wm M M M M M Mir M <br /> 720 Olive Drive, Suite D <br /> /FF Davis, CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL ccc Fax 530 297 4503 Lab No -y07,2 Page of <br /> Project Manager Phone No <br /> J0 6C -1 S y 3 2- p Chain-of-Custody Record and Analysis Request <br /> Company/Address 09 13.x V(5 9 FAX No <br /> o -� C-1703 5<-/ 7 V-& Analyses Request F <br /> Project Number PO No Email Address o x <br /> ❑ Of ❑ xis ❑ doc ❑other o c N W <br /> mProject Name fl-hi N Sampler Signature o 0 3 >, <br /> Project Locate n "' ? m m m a o = 0 <br /> w in w eya ea o <br /> da W 0 r H <br /> a0 m = S m N U `—" C <br /> Sampling Container Preservative Matrix H o E r ° N o - g -Cq <br /> r <br /> Q 00 Cry m $ F- m v r O <br /> ON 2 d 4 (Yi tv m t6 C > m a r LL <br /> Sample ' > u, W 0 3 0 Q N � N <br /> J X ca Go <br /> Designation Date Time v n s 0 z 0 LU a a a o 0 0 o m o L <br /> m m H H cn r- Ln l- —J W > <br /> f �i0 �z <br /> opt r'�c wr!( lY .,c5 <br /> ;elinquished <br /> elmgwsed by Date Time Received by Remarks <br /> by Date Time Received by <br /> Relinquished by Date Time Received by Laboratory `f fr Bill to <br /> rl r 4/t� <br /> Distribution White Lab Yellow File Pink-Originator Formslcoc 062801 fh9 <br />