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CHAIN OF CUSTODY RECORD BC Log Number <br /> Client name Cal I Project or POM Analyses required <br /> Address � Phone M \ <br /> qq <br /> City State Zip Report ttenttori <br /> Type Sampled by y ac <br /> Lab _ Lut Number o�r <br /> Sample Date Time See key of ti <br /> number sampled sampled below Sample description containers d°y� Remarks <br /> i <br /> M► �Z Z (Z --Sotf <br /> Am Z e 3 <br /> �-- zv <br /> Signature R4fp4n <br /> Print Name Company fDate Time <br /> Relinquished by y--x�' � 1oit— I ,+ l� -1' I /'aReceived by ' !ai ✓w V t 1 L W (�[J <br /> AA M <br /> Relinquished by <br /> Received by ]3C l Z 3 <br /> Relinquished by <br /> Received by Laboratory <br /> BROWN AND CALDWELL LABORATORIES Note <br /> 1255 Powell Street Emeryville CA 94608 (415)428 2300 Samples are discarded 30 clays after results are reported unless other arrangements are made <br /> Hazardous samples will be relurned to client or disposed o1 at client expense <br /> ❑373 South Fou Oaks Avenue Pasadena CA 91105 {ete)795 7553 <br /> 0 121x1 Pacdreo Avenue Anaheim CA 92805 KEY AO—Aqueous NA—Nonaqueous SL—Sludge GW—Groundwater SO—Soil OT—Other PF—Pelroleum <br />