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RE a <br /> 720 Olive Drive, Suite D <br /> ,�� Davis, CA 95616 <br /> Lab 530 297 4800 ` <br /> ANALYTICAL LII Fax 530 297 4803 Lab No r 3 7Lt � page I of <br /> Project Manager Phone No <br /> (916) 3S4 - 3 1 Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No t` For Lab <br /> Rq "4 e L- ii v a r a+I ..t a►t f 4 (9 t 0 3 S � - t} a C Analysis Request Use Only <br /> Project Number PO No Project Name icowE T(x)co y <br /> 0 - M g K h e c t_ W W 3 <br /> Protect Location Sampler Signature <br /> TOTAL(xl 3 <br /> ioo1 6. Yose64i to Avg MIw tteca- i t <br /> m <br /> ui 00m is <br /> Container Method Co LO to <br /> o o <br /> Sampling (Type/Amount) Preserved Matrix - a a N z r <br /> inH H e Co <br /> p a .. m m w a; L'i N a <br /> o z o m ° o o C4r <br /> O c c c c <br /> Sample � � � E �, W Lu °� � m Go N <br /> p o w o zz W o a z -T ° ° ° ° w w v N <br /> Designation Date Time CO n z= z m <br /> 4ilm 11co 1 X <br /> Ito <br /> SP� l ' `t ttt5 t X 5 <br /> sr 2- I IL30 IX 5 <br /> 7. -1J w5 I S r <br /> 5r 1- 31 1140 11 S <br /> SP - i-4 1141 I x S <br /> SP - ..I1, I-110 I X 5 <br /> S F - 3 2 ILLN I Is <br /> Relinquished by De Time Received by Remarks N o t t, 2- 111- 1 Com pas i to y <br /> J Z I14' ,— - - <br /> Relinquished by Date Time Received by Email address <br /> ❑ doc ❑ xis ❑ bit ❑other <br /> Relinquished by D to Time Received by Laboratory Bill to I't a M a 1 t h Y I Y't?ft iii{t N <br /> Distnbution White-Lab Yellow-File Pink-Onginator COC fh8(9/98) <br />