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1135W. Sunset Blvd. Suite A <br />Rocklin, CA 95765 Excelchem Ph- 916-543-4445 Fx: 916-543-4449 <br />CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br />N. _ <br />Project Manager: Kate Albertsen Phone #: See above <br />X <br />- <br />Electronic <br />.PDF <br />Geotracker <br /> Other (please <br />Data <br />(ciobai <br />specify) <br />Deliverables Request: <br />ID) <br />Email <br />Invoice <br />Address: c <br />JoeTexcelchem.net <br />r r <br />KateAexcelchem. net - c: <br />Company/Address: See above Fax #: See above a.. <br />To: <br />ChrisCexcelchem. net <br />ANALYSIS REQUEST Page of <br />Project Number/P.0#: 2207177 Project Name: 2207177 [CAM 16 DUE: 5 Day TAT Bin#: <br />Due Date: <br />Project Location: Rocklin, CA Sampler Signature: <br />Work Order: <br />Sample <br />ID <br />Sampling Container Method <br />Preserved Matrix <br />LAB USE <br />ONLY: <br />Date Time VOA Clear Liar 4 oz 1 a_ Glass Jar IHCI IHNO3 [ICE/NONE Na2S203 [Water [WOOD o w <br />BH1012 07/20/22 11:00 X X X X X <br />Relinquished by: Date Received : _ Remarks/Condition of Sample: <br />SSAL Vegas <br />5 Day TAT <br />Relinquished by: Date Receercl--byra-boratory: <br />SI <br />06730 Bill To: