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Chain ® st® y ®r PLEASE CLQU nW. <br /> Laboratories,Inc. sct.QuoTe>D; <br /> .,port To: 57300 <br /> ' ' . • <br /> Client: -af r 4 t y 5 e c(a c 5 Telc <br /> Pro'ect#: Page-!— of <br /> Attn: c+v: �(•. �,�e"; C Project Name: 'G CSC 5 . Comments: <br /> Street Address: & `a Ow ':1-4 " ; Project Code: - x <br /> z <br /> t . <br /> 'Sampler(s): c , e -sb'City,State Zi � �i B , ° lij'_ <br /> Phone: ;3 ��3 119 Fax: �J qc" c, e�u a s ,r V ea Cx Trr,ckt �(0 Zo":SS 4 z`3170 <br /> Q) Sam le Matrix Are there any tests with holding times less than <br /> Email Address: Al --f � ''.i P cjf c c SrC4 p� or equal to 48 hours? <br /> m o� ❑ Yes No <br /> Submittal#: ���a �� 3 3 M 0 <br /> 0 <br /> Standard Turnaround=15 work days <br /> • • • • n° A C7 Other Notes <br /> 1 107 1120 � l� <br /> - rr 1 e Well#Z �� Z- 1+3 X � � <br /> Well Z c ii° 4' 2= )1-10 H i <br /> 12c� <br /> Indoor 9cauc - <br /> in wr IZG )C - <br /> Sample Disposal Special Reporting <br /> ❑ Report Drinldn <br /> • Same as above p g ❑ QC ❑ WIP ❑ Raw Data <br /> � (' Waters on State Form? ❑ Return to Client Disposal by lab ❑ Archive: Months--------— <br /> t'G ru-,4,,r L, - 1. Relinquished By Date Time 1. Received By Date Time <br /> Client: El Yes No ^ �'��'f"'�'�� <br /> 350 <br /> Address: <br /> `i` ----- 14 ss� �r �l a7 +350 r' � J>e 0, ime <br /> Send Copy to State of 2. Relinquished B Date Time 2. eceived By <br /> Time <br /> 4 Y �1 <br /> City: 'MO n t4e�� State � Zip <br /> CIS� CA, <br /> Attn: t Yj Yes ❑No 3. Relinquished By Date Time 3. Received BF Date Time <br /> PO#: L� <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield, CA 93308-661.327.4911-Far:661.327.1918-www.bclabs.com <br />