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J.... <br /> � _ <br /> �•+ <br /> / .3153 <br /> Phone: (918 979-1950 BCR & Associates, Ltd. Send F=To: BCA d AReoolaloa, Ltd. <br /> FAX: (910) 979.9450 3550 Wei! Ave. 1140 <br /> Chain of Custody Record/Relqu�estq for Analysis Secramenlo, Callrorn[a 95821 <br /> Site Address: �d3 -o{k�, F S�vrc�' S4rick, Y+��yt IT rrlcd�r~�dSON Sample Condition <br /> f Chllfed and Intact ❑ <br /> Project Number nae <br /> Y7C` Y�1c <br /> Shipped By: <� No Iieadspace or Air Bubbles El <br /> C' y'1 t/ Preservatives ❑ <br /> Shipped To: 5Note Irregularities <br /> Sample Location Field Sample Date Matrix No. of Analysis/Comments <br /> Identification Containers <br /> 90 <br /> 076�1 <br /> Sampled By: <br /> Date/Time: <br /> Sealed For Shipment By: Date/Time: <br /> Relinquished By: <br /> Date/Time. <br /> Relinquished By: Date/Time: <br /> Recleved For Lab Date/Time: 3 IYJ9 4 — d <br />