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CD <br /> -a <br /> 0 <br /> o a =r <br /> z1-1 C LABORATORIES, INC. Chain of Custody Fort <br /> QD rt ' <br /> Anal <br /> s Tient: �— Project#: Q101011 pS 13 sis Requested: <br /> ' Page_of Cn <br /> o 3 <br /> Comments: a 3 Q" <br /> o y \ttn: Project Name: yy �l �`.� .� m <br /> G3 OO <br /> _ iv <br /> 0 Street Address: SS°(D 1 a; a � <br /> o ? ;ity,State,Zip: (,d Sampler(s): <��t� �; 0 T <br /> C5 < O <br /> O <br /> o phone: Fax: <br /> m r <br /> Sample Matrix Result Request **Surcharge " o <br /> :mailn�,cp� A <br /> m 2 L1 <br /> Nork Order#: V .^ 1V� m ❑STD L]5 Day** El Day** ❑1 Day"* <br /> y 'v 1 "J D 3 (70 days) •a' 1 <br /> W 9Date Time <br /> z <br /> Q ar Y c m 3 <br /> N e Description <br /> - 'O C N <br /> N <br /> Sampled Sampled �� i n �n o c7 Other Notes O CD <br /> CD k- 25 0 <br /> >C-) <br /> D M5W C n O <br /> m <br /> ° -I (°j�^�' 7L I(y tj 00 <br /> o S N <br /> A <br /> V <br /> C <br /> oo <br /> O <br /> -n tea A <br /> rn c <br /> V y <br /> W Q <br /> o � <br /> 0 � O <br /> F R ° Same as above EDF Required? Global ID _ q / / System# <br /> 6 y Geotracker (Neetled for EDF) .S ,' S D Z J (�e (Needed for EDT) <br /> Tient: Yes ❑NO t• linquished y Date Time 1.R wed By Date Time <br /> address: <br /> o Send Copy to 2.R FPquish �By Date Time 2.Received 8 Date Time <br /> ° amity: State Zip State of CA?(ED7) '(CC%¢ © -71261 <br /> 2L <br /> a %ttn. El Yes El NO 3.Relinquished By Dae Time 3.Received By Date Time <br /> a <br /> ?O. <br /> a � <br /> BC Laboratories, Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911 -Fax:661.327.1918-www.bclabs.com <br /> v <br /> 0 <br /> ,v <br /> G <br /> A <br /> O_ <br /> W <br /> O <br />