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M4F M M i M i M 1117 r I r liiiiiiii IF I� <br /> CHAIN OF CUSTODY RECORD � � BC Log Numbi:r <br /> Client n e r Project or PON U Analyses required <br /> Address C"5 co 2 �VCL .$ f a <br /> o� <br /> C Slate Zi Re <br /> �- G <br /> ya oc <br /> S ed by <br /> Lab ��e. by Number <br /> Sample Date Time See key t/ W t of <br /> number sampled sampled below Sample description Containers lj , c�c�Qe Remarks <br /> A;.L + J� <br /> atum Print Name Company Date Time <br /> i <br /> Relinquished by <br /> Received by 7 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory (,JQ l ( r <br /> IIGI 1 <br /> ATORIES rbc r Note <br /> 300 Samples are discarded 30 days atter results are reported unless other arrangements are made <br /> Hazardous samples will be returned to client or disposed of at chant expense <br /> sadena CA 91105JM7553 /� Q <br /> L_112oo Nr,f=Aywnu2.Anaheim (.A 92805 l KEY AO—Aqueous NA—Noeaqueous Sl—Sltrriop (,W—(irnun,1witnr CQO—�nO r17._f)-x Pf•—P <br />