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SC Log Number <br /> CHAIN OF CUSTODY RECORD <br /> O -4 <br /> Cli ame Project or POs Analyses required <br /> Address v P ne s <br /> 723 S �• �iG 4¢4 o i z 3 ,� r'�� ��� <br /> City, P p Lary <br /> Ci State,2i Report attention <br /> * Z4- <br /> Sampl d by <br /> Lab 1'� t �j� a ^ .-6 `0� Number <br /> Sample Date Time See key o--+1 at <br /> number sampled sampled below Sample description containers fi Z�y� Remarks <br /> 4- <br /> G? <br /> ••o law <br /> 3: S w <br /> -tTt 3 G u 4-7 , - Ara - 57 <br /> _� <br /> i <br /> -4, <br /> Signature Print Name. Company / Date Time <br /> Relinquished by G rVGr 'F Y • Q <br /> Received by <br /> Relinquished by < r <br /> > rS <br /> Received by �z ;o � <br /> Relinquished by <br /> Recelyedby Lebora,o Z/Z�2J <br /> BROWN AND CALDWELL LABORATORIES Note, <br /> 1255 Powell Street,Emeryville,CA 94608 (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 baks Avenue,Pasadena,CA 91105 (818)795.7553 <br /> ❑ 1200'PacilleoAvenue,Anaheim,CA 92805 KEY: AO--Aqueous NA—Nonaqueous SL—Sludge GW—Groundwater $0—Soil t7T--01her 'PE—Petroleum <br />