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CHAIN OF CUSTODY RECORD � BC Log Number <br /> Chem name <br /> Project or PON Analyses required <br /> Address ! _ Phone N <br /> C?( 3 65 <br /> City State,ZIP Repo�tfitnfion <br /> ry`l NSI! F I U F/---,v�T-IL QAO�� <br /> Sampled by <br /> Lab Number gra <br /> Semple Date Time See key � <br /> In sampled sampled below W •• <br /> Sample dewiption containers <br /> `Z'S Remarks <br /> 13! Z <br /> Ea <br /> Signature '3 Print Name Company Dat Time <br /> Relinquished by f <br /> Received by J <br /> r <br /> Relinqura <br /> Recelved by <br /> Relinquished by <br /> Received by Laboratory <br /> BRov�N AND CALDWE� TORIES 1. Note <br /> JD 1255 Powell a Cil 94608 (4t5)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 /> Q'373 Sbuth Avenue, t;,/l 91105 (81B)795 7553 <br /> tion Avenue Anaheim CA 9280--,—, f` �S 'KEY AQ--Aqueous NA—Nonaqueous SL—Sludge GW—Groundwater SO—Sod OT—Other PE—Petroleum <br />