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X <br /> CD0 <br /> o a n <br /> C> = 3 <br /> A <br /> co o <br /> JB: LABORATORIES, INC. Chain of Custody Form 0 <br /> C) <br /> a n m <br /> c <br /> Rep.l T. Cn <br /> s Client: 4-e5 Project#: • ' <br /> Page--L—of Q n <br /> 4 t P Comments: <br /> C <br /> G Attn: PC Project Name: rhe, i} v <br /> Street Address: r Q - <br /> C3 City,State,Zip: (�� e)doi Sampler(s): p 5 <br /> x o <br /> G ° Phone: Fax: m <br /> Email: Sample Matrix Result Request -Surcharge <br /> C-) <br /> W!''�c Co• tp v C/1 <br /> //�a� n o <br /> Work Order#: U— V q l 3 3STDDi❑5 Day— ❑2 Day"" ❑1 Day"" 'a <br /> Samplern <br /> Description <br /> Q 4t 1= Z2 2 o CD <br /> N w (n o 0 3 Other Notes � � • <br /> o -5" Z.o CH j TRI 3UTI.ON <br /> o SUEUT OI <br /> Wap d <br /> V <br /> 09 - 1 <br /> o, <br /> 0 0 y <br /> TZryLt-" <br /> -Z t LS 2 130D BAS COT <br /> �aZA <br /> CO o p <br /> w n' <br /> 0g^Z� t3�3h <br /> • ame as above EDF Required? Global ID System# <br /> m w ° Geotracker (Needed for EDF) 5 r L 7 (Needed for EDT) <br /> Client: �: � `�--3.s�6 <br /> y [ s ❑No t R ' quished B Date Time 1. a ivea ey ` Dates Time <br /> 14-K ki'jd <br /> Address: <br /> Cit State—Zip— Send Copy to 2.Rel' wished y Date Time 2.Received Dae Time <br /> o y' State of CA?(EDT) , /6 <br /> Attn: �� S ! �; 1 <br /> ° Yes ❑No 3.Relinquishe y` Date Time 3.Received By Date Time <br /> W.O.#: L 1 t-P ZtS <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911 -Fax:661.327.1918-www.bclabs.com <br /> � s <br /> i' <br /> m � <br /> 0 <br /> N <br /> (D <br /> W <br /> O_ <br /> N <br /> W <br />