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CHAIN OF CUSTODY RECORD BC LOG No. <br /> Client name ,y Job number Analyses required <br /> 5 5 O <br /> Project name <br /> Site l -Iv(fsa7A <br /> r Sampler(:) <br /> Project manage <br /> Type �(7 d,� r� <br /> Sample Date Time Composite Number 4' n�'` �a <br /> number sampled sampled or Semple description of otic Remarks <br /> Grab containers <br /> TSP I �-�3 l ' 10 5oi ) S C) l i LQ I Ct ` k1 V Q i <br /> TS' Y Y, <br /> xx, <br /> r c vt I <br /> e r�yVLe✓�-Fo CA <br /> - 0 23 <br /> Signature Company Date Time <br /> Rellnquithed-by� <br /> l <br /> Received b <br /> Relinquished by \ <br /> Received by <br /> Relinquished by <br /> Received by <br /> BROWN AND CALDWELL Analytical Laboratories Note: Samples are discarded 30 days atter results are reported <br /> �b oo Creel, meryv C�14608 fi41 )�47S,2 00 unless other arrangements are made, <br /> 37�� uth Fair 0 venue, Pet9f-t05 (21 of <br /> Hazardous samples will be returned to client or disposed <br /> Tof at client expense, <br />