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CHAIN OF CUSTODY RECORD BCA Log Number <br /> Client n e Pro ect or PON <br /> ir(0 I Analyses required <br /> w <br /> Address Phone N <br /> Z S� <br /> 916—zN 41—p 12 \ ma <br /> Cil .State,Zip Report attention S <br /> oC 8 �QCA <br /> h�a <br /> Lab Type' Sampled by � <br /> Sample Dale Time See key V Number of <br /> number sampled sampled below Sample description containers gyp] �a�Qm Remarks <br /> 1 F-5 fJ Tu6e <br /> E u6e, 3 -- ---- <br /> - , 5,l� ti Ub <br /> E: 0 'Q01 KA 1 <br /> n 5, ►� <br /> 1 <br /> E Signature Print Name Company Date Time <br /> 1 <br /> Relinquished by /� L, ife r— rO',n — J � /L" <br /> Led an a <br />+ Received by tom- V ' / W <br /> ARU TjkA Relinquished by <br /> Received by —-- -- —�— — <br /> Relinquished by <br /> Received by Laboratory — -- — <br /> B C ANALYTICAL NotE:Samples are discarded 30 days cher results are reported unless other arrangements are made, 'KEY, AO—Aqueous NA—Nonaqueous SL—Sludge <br /> 1255 Powell Street,Emeryville,CA 94608 415 428-2300 Hazardous samples will be returned to client or disposed of at client's expense, <br /> S^' � 1 GW—Groundwater SO—Soil b701her F'E---Petroleum <br /> ❑ 801 Western Avr^ Glondale,CA 91201 (818)2475737 Disposal arrangements:_ <br /> ❑ 1200 Pacifico A. Anaheim,CA 92805 (714)978-0113T T r r <br /> 1 <br />