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CHAIN OF CUSTODY RECORD I yo 63 SC Log Number <br /> AdIL- <br /> Client name t f Protect or POp Analyses required <br /> Ill t l��-iy1 3r�w n �4 if (e'2—-7 -- U <br /> Address /�1 ( Phone q f <br /> ' 4iLVd� nv-0- Ihc�D� 1'1 - Lk)i-)-3 acv �P <br /> City,S to Zip 7-1 Report <br /> ntion <br /> Sam fa � Q' <br /> Lab Type P y / vl1it l Number <br /> Sample Date Time See key of <br /> number sampled sampled below Sample description containers /� y� Remarks <br /> �l•Z I l�r d � llh � QY� � �t 6� <br /> lr7 C)X—� <br /> Le <br /> a <br /> Ch M �t 44 <br /> 5 <br /> O'er 6MV <br /> PAM <br /> rlu <br /> U UYl D � <br /> Signature Print Name Company Date Ti <br /> Relinquished byf 1 Z( <br /> p � -v---~ ►�, 1M , �-.�tr too wu.� L)� ��- <br /> A'� <br /> AwAwed by cuL 7D&-sck AV k� C CI <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory <br /> BROWN AND WE L LABORATORIES Note <br /> ❑1255 Powell Street,E le,CA 94808 (415 428 2300 Samples are discarded 30 days after results are reported unless other arrangements are made <br /> Hazardous samples will be returned to client or disposed of at client expense <br /> ©373 South Fair Oaks Ave u Pasadena,CA 91105 (818)795 7553 <br /> ❑ —Aqueous NA—Nonaqueous SL—Sludge GIN—Groundwater SO—Soil OT—Other PE—Petroleum <br /> 1200 PactCico Avenue, nabs[ CA 92805 KEY AQ <br />