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PLEASE COMPITTI <br /> XBC > Laboratories,Inc. Chain of Custody Form <br /> Rep�rf To. i E <br /> Client: HRrS:t t Project#: PageJ— of--L- <br /> A <br /> Attn: Ec,-icAV.Sbi,,d-I?,- Project Name: Y(, VCP6 5"V4 Comments: <br /> Street Address: 400 5,14�Llyjj (�t&A& Pr!�ject Code: 1,1) JAI A+-Cf <br /> _City,State,Zip:St.(ACV jos.,1110 001 Sampler(s): D�A <br /> �-Lt <br /> Phone:43(-q3j-cjjJ I Fax: (,j6-q34?-j7S) jk¢ ,j l BCtS CPT -L14 -(,r W&US' IZ,4 <br /> Sample Matrix Are there any tests with holding finies less than <br /> Email Address: or equal to 48 hours? <br /> Submittal#: 0 ❑ Yes No <br /> Standard Turnaround=15 work days <br /> the i 4, A <br /> V�U5 IM 0 i�: Other 1 Notes <br /> 2 / Y' 74 <br /> 117JUCI 63(? x <br /> Blenk 0—'VVZII L<YA, <br /> YA-0 x <br /> YA 1 (210 x <br /> CR, Eija, c,,kL c X <br /> I p/clie --I lb4s <br /> k 1 117161 <br /> Same as above Report Drinking Sample Disposal Special Reporting <br /> Waters on State Form? ❑ Return to Chem IyDisposal bylab E] Archive: Moiiths-------- El QC El WIP EIRaw Data <br /> Client: arw-iar4 taJ-4,i 1 1. Rel " bed B are Time 1. Received By Date Time <br /> Address:-119—q---��� Rot E]Yes k No inq Date <br /> FQ467.X I /17/0 72.5 <br /> City:140-11t-�--�----State CA zip 15 3X Send Copy to State of 2. Relinquished By Date Time 2. Received By Date Time <br /> CA? <br /> Attn: -f '10, <br /> bc�-w — yes E❑-1 No 3. Relinquished By Date Time 3. Received By Date Time <br /> IPO# 9 <br /> : V <br /> BC Laboratories,Inc.-4100 Atlas 0.-Bakersfield, CA 93308-661.327.4911-Fax:661.327.1918-www.bclabs.com <br />