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BC <br /> Laboratories,Inc. Chain of Custody Form <br /> rtFt.a�LcgMtr_t_Tr: <br /> Repan To., 57273 <br /> Client: a�rz.t5' ,lc, Project#: _ Pae of <br /> Attn: tri Project Namc•�•.�Ir'rC � r� tsS Comments:91��c'l�1lt2�� �'-/&T�,- <br /> Street Address:4(,J2.5.hycr &PJ Project Coder <br /> City,State Zi :SF64Cde ' A40 30 Sam ler(s): ,* J V'S 6/AJ f.•- <br /> Phone• `_ Fax: (2-25,1175' w1 ... <br /> Samlle Matrix Are there any tests with holding times less than <br /> Email Address i tFi^ t55 f(�tC L r;�y 0 t Y- ❑Qr Beat to 48 urs'No <br /> Submittal#: <br /> Cl 3�a' E 3 *Standard Turnaround 15 work days <br /> --- <br /> a o •• • rn vz swl U Cather Notes <br /> i e � 'lis n G zw�c+�• 1'�a e 9 f 1 07 OF 5 <br /> 7B_ 1,m k e C- 4::" z Cl6 ' � 01 <br /> A f I aizo <br /> I I JA 107 <br /> Dull IV <br /> i <br /> 9 <br /> Report Drinking Sample Disposal Special Reporting <br /> Same as alcove ❑ QC ❑WIP Raw Data <br /> �^ Waters on State Form. Return to Client Disposal by lab An:hive: Manths__________ <br /> Client: -ds y+n/raf }" 1. Relinqu''he y Date Time 1. Received By Dat Time <br /> ❑Yes No <br /> Address: __ _ jr2t, rd L�►W1I53x �l l a2 <br /> L,' A Send Copy to State of 2. Relinquished By Date Time R}ectved By Date Ti e <br /> City: r1�(x�_ _State _Zip CA? C mfi 1 t ' - R <br /> Attn: yes F1 No 3. Relinquished By Date 'Time 3. Received B Date Time <br /> PO#: TTT"` <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911-Fax:667.327.1918-www.bclabs.com <br />