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CHAIN OF CUSTODY RECORD ! r �� C <br /> C v � BCA Log Number <br /> Client name Project or PON <br /> 1 Analyses required <br /> Address , Phone N r <br /> 5/v Y_ck a <br /> Y! <br /> City State Zip Report attention <br /> h,// C,< ' Ys 3 - /r- <br /> Lab Type Sampled by V Q <br /> Number <br /> Sample Date Time See key of C <br /> number sampled sampled below Sample description containers /� P� Remarks <br /> i /aS5 c,J w-02 3 <br /> 5 (5;c--) -3 s 13 - <br /> gnalur Print Name Company Date Time <br /> Relinqulshed by V�'n J� / a S <br /> �3cy' / L/i c�' <br /> Received by — <br /> Relinqulshed ~ <br /> Received by <br /> Relinquished by <br /> Received by Laboratory 1 (� t On QLA 1) TZ <br /> B C ANALYTICAL Note Samples are disc rded 30 days after results are reported unless other arrangements are made KEY WW—Wastewater SU 5urfacce Water SO—Soil <br /> El 1255 Powell Street Emeryville CA 94608 (510)428 2300 St.—Sludge Hazardous samples will be returned to client or disposed of at client s expense a PE--Pelroleum OT--Other <br /> ❑ 801 Western Avenue Glendale CA 91201 (818}247 5737 Disposal arrangements NA—Nonaqueous GW—Groundwater AO—Aqueous <br /> ❑ 1200 Gene Autry Way Anaheim CA 92805 (714)978 0113 <br />