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Laboratories,Inc. Chain of Custody Form <br /> Client: I-avi regW_, ' &5ec-jr--4e-S. Project#: 61 O d7*t 04-- Analysis Requested raLe--L of <br /> Attn: . 4-td- P Project Name: ^yno-%J?e / I I Comments: <br /> Street Address: �5• t} C� Global ID#:5�'L� T'0�35�6 10 D F lb d lL�rlc I•t r��, <br /> city,State Zip:SIVA WeCK140 III Sampler(s): DAyjA6rk � I t D F 4" <br /> Phone: Flax: se.r <br /> Sample Matrix Are there any tests withholding times less than <br /> Email Add o4kir� twCnt,Lo�+ _ b� <br /> or equal to 46 hours? <br /> �7 lWyes <br /> Work Order#: �-- � } d` 3 g El No <br /> Sample a y Vale <br /> , - 1 o. _ E 3 *Standard Turnaround=10 work days <br /> V o F o <br /> Sampled Sampled Q� wI— z rn° A CEJ Other Notes <br /> O8-- I 1 1B I t3 bgo3 <br /> Z. O 6-A 104 <br /> 09- 5 of 1 <br /> 09- Ito <br /> QB- CH BY is <br /> � D — 11 131 <br /> MU-0UT <br /> Dg- 1 <br /> 0993 <br /> © _ 161-+ r+ NO2 O <br /> ® d 0 C12 BOD <br /> N MEAS r--Ir <br /> D 093S <br /> ISame as above EDF Required? <br /> Client: ❑No 1. linquish Date 1Yme 1. 'ved B Date 'l5me '9 <br /> �es ��•rj /- U <br /> Address: ————— r <br /> Send Copy to State of 2. nquishe y Date Time ived Sy Date Time <br /> City: State Zip CA?(EDT) _ •( EO[ /3 1 <br /> Attn: El Yes El No 3. inquished By Date Time 3. Receiv Date Time <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield, C 308-661.327.4911-Fax: 661.327.1918-www.bclabs.com <br /> 1-63-1-5 -13 '30 <br />