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Ecl>bLzboratories, Inc. Chain of Custod Form <br /> cly <br /> Report To., . % —1 Project#: 28B Page of A— <br /> Comments. <br />��Ltn-- ' 1 i <br /> 1 17(?( <br /> -% <br /> Street AddressAv.'s H" CH A),Oof-,;,rikio Project Code: <br /> City,State,Zips 1-1(11,Ael Sampler(s): <br /> E- OT 1-116 4r Well <br /> gho <br /> Fax: <br /> Are there any tests with holding tinies less than <br /> 1�1, <br /> or equal to 48 litours? <br /> Email Address <br /> 414 J,12 CSapie Matrix,,�, e -�4wAkk Oft <br /> Submittal#: 0 ❑ Yes No <br /> r Standard Turnaround=15 work days <br /> Other Notes <br /> Lr <br /> 1 4 YA 4 <br /> Wo 1 4 0,p I-Ic IA 14o 1K A X1 <br /> 14 <br /> 14z 5 A i IL <br /> i 1 2-' 6 YA $'Z 1,Lt3l 1130 X X\ I RL <br /> vve,I i YA" 2 <br /> I I -S os X X <br /> rhdoy-r- F-C,1,11(e.. -F, J.'r, C. <br /> Tr 9 IA f% k <br /> .............. <br /> Saute as above Report Drinldng Sample Disposal Special Reporting <br /> W ❑aters on State Form? ❑ R!�lurn to ClientDisposal by lab El Archive: Months----------- OC 0 WIP E] Raw Data <br /> 1. Relinquist B Date Time 1. Received By Date 'rime <br /> Client: L("A 0 <br /> El Yes IV No SJ 71d GIS <br /> 5 A, RA, 05�), — <br /> Address: Relinquished By Date Time Time <br /> By Date <br /> (6361 SendCopytoStateof e 2. Received B <br /> City: AAIA(A State zip3 <br /> CA? <br /> ilTime <br />(Att.-, C4+t• <br /> krth (/A r Lk A'I 3. Relinquished By Date Time 3. Received By Dat t'`" <br /> J Fil Yes El No <br /> iT—0#— <br /> BC Laboratories,Inc.--4100 Atlas C1.-Bakersfield, CA 93308-661.327.4911-Fax. 661.32'7'.!918-www.bclabs.com <br />