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� MVW M i MM M M MM M M M =6" <br /> W <br /> CHAIN OF CUSTODY RECORD <br /> Chant n e BC Loci Number <br /> /� Project or POM <br /> Ad <br /> r ! Anutyses requited <br /> C Stats Zi a <br /> Re ort I [ion 1" <br /> 04 <br /> Lab 5 e by <br /> <C' <br /> Sample Dale Time Seeee k key Number <br /> number sampled sampled below U1 C� tia�o <br /> Sample descnpuon containers <br /> Remarks <br /> C&W <br /> d <br /> �SL)1`j r r <br /> I <br /> ature Pant Name <br /> Company Date Time <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory (T <br /> A70RIE r� 1 ��( S� f/ r Nose <br /> (,L i! { Samples are discarded 30 days after results are reported unless other arrangements are made <br /> sadena CA 91105 818 7553 /� h Hazardous samples wdl be returned to client or disposed o1 at them expense <br /> F1 1200nahe,m CA 92805 ( r 64-- <br /> _. KEY AO—Aqueous NA—Npnaqueous SL—Sludge GW—Groundwater SO—Sod OT---Olhor PE—Petrofoum <br />