Laserfiche WebLink
720 Olive Drive,Suite D <br /> .�� Davis,CA 95616 <br /> Lab 530 297 4800j <br />' ANALYTICAL LLC Fax 530 297 4803 <br /> Lab No ` 3 Page ZLL of <br /> No <br /> Project Manager PhoneN <br /> To t 4 t No �s -3 Z s a Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No !— For Lab <br /> R4 wt k f- kv i ro k wt t K h t (9 tO 351- - 1 f 8 Analysis Request r use Only <br /> Project Number PO No Project Nameo a WET(x) <br /> R IN0 -- MK�eca.. o <br /> N N <br /> 00 <br /> X X TOTAL(X) <br /> Project Location Sampler Signature N r- <br /> I001 �_ cstl~tl`�e Ave MRItte« 0 m m <br /> Container Method o co <br /> _ _ _ <br /> Sampling (Type/Amount) Preserved Matrix y '2a. a CMo N z <br /> 0 C7 vn'i 0Pcq 3: 2 to4 <br /> N <br /> O a��o air aCi a air o to <br /> n! L <br /> m n v (d v <br /> Sample ' W g � w w w 0 ° ° z � <br /> •p o f a 0z w 0 ¢ a n. 0 0 0 0 9 a N <br /> Designation Date Time � � , z = z m r 0 0 ti w w r v r <br /> 5�l# - CSW 9�9 4 160 k X vl► X X �� � <br /> Relinquished by Date Time Received by Remarks <br /> Relinquished dy Date Time R ived b q�lo Email address <br /> wk _f z ❑ doc ❑ xis ❑ txt ❑other <br /> Relinquished by Date Tune Received by Labofitory Bill to RoikwtQy e. <br /> Distribution White-Lab, Yellow-File Pink-Onglnsfor COC 1118(9198) <br />