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CHAIN OF CUSTODY RECORD SCA Log Number O 0 VQ <br /> Client narya- UJB N /{//-C Pro ed or PO# Analyses required <br /> Address . Phone <br /> 7111 ,,:�L) 1 7-2-4 /�2 � <br /> City,State,Zip Re attenti n ` <br /> Sampled by <br /> Lab Type' Number <br /> Sample Date Time See key of <br /> number sampled sampled below Sample description containers Z�caQm� Remarks <br /> _'Z QST fie 5��1 TPt/ <br /> F1 <br /> Si Print Name Company Date Time <br /> Relinquisnedh <br /> I Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by 7Z �Z <br /> Received by Laboratory <br /> B C PMALYTICAL Note: Samples are discarded 30 days after results are reported unless other arrangements are made. 'KEY: WW—Wastewater SU—Surface Water SO—Soil <br /> 255 Powell Street,Emeryville,CA 9460 (510)428-2300 Hazardous samples will be returned to client or disposed of at client's expense. SL—Sludge PE—Petroleum OT—Other <br /> 801 Western Avenue,Glendale,CA 91201 (818)247.5737 Disposal arrangements: NA—Nonaqueous GW--Groundwater AQ—Aqueous <br /> 1200 Gene Autry Way,Anaheim,CA 92805 (714)978-0113 <br />