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720 Olive Drive,Suite D <br /> Davis,CA 95616 <br /> ��� Lab 530 297 4800 <br /> ANALYTICAL LLC Fax 530 297 4803 Lab No �e!ry <br /> Page { of Z <br /> Project Manager Phone No <br /> J J R 4 t No 5 _ 3 a Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No t- For Lab <br /> N't.1 -Ly e F / e s+1 m z k f< 1 (9 to 3 5 - L } $ Analysis Request r use only <br /> Project Number PO No Project Name C-4 m we (x} <br /> r {� >N Q - j`1 a K t c,►�.. rorAl {x} C, <br /> Project Location Sampler Signature N .. 3 <br /> 0 <br /> lot,I E Ycseinct>✓ Avz o m m <br /> Container Method � _ <br /> Sampling (Type/Amount) Preserved Matrix N o n a ° � z t <br /> o C7 vim, o w N m N <br /> Q (n d c c c e o O N r <br /> O, n W H m ~ 0 � � X co � v U CV <br /> Sample o J J o v z W o Q a a o 0 0 9 a N <br /> Designation tate Time r z = v Z m ti �+ ^ w <br /> SBI - { - 9(Z(99 910 l S X X -01 <br /> StsI -to 920 I x 5 X X - 0 ;� <br /> S61 - 25 935 I X X — 03 <br /> sm I - Gw x wx x -- oq <br /> SQz - 15 1e1S 1 X S X X - dS <br /> SBI - 20 1030 l x X <br /> Sp2 - 25 io 1 x S x X --07 <br /> sa 'z - C'w ltaso 4 x X w X eg <br /> 5 3 - <br /> IS t1tS-- 1A 5 X X — q <br /> 563 - 1U 1135 1 X L . <br /> X X - / O <br /> Relinquished by Date Time Received by Remarks <br /> Relinquished by Date Timr--111:96ived by Email address <br /> ❑ doc 1:1 As ❑ txt ❑other <br /> Relinquished by Date Time Received by Laboratory Bill to RR w q q 0 hY j fro 4*1,f tl fq <br /> ?0 00X $b tZ4wcka K%rrlt gS683 <br /> Distribution White-Lab yeflaw-File,Pink-Originator COC the(8188) <br />