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PLIAIII.COMPI-1-IF.: <br /> Laboratories,Inc. tilt. L122 <br /> Chain of Custody Form <br /> E <br /> Repon To: 585G5 Page of <br /> Rep <br /> " lr A 37. C' Pro <br /> Client- 5 d e'#(A'te.5 -ject#: <br /> Comments: <br /> ProjectName: <br /> PA <br /> 0 crop 'Eon;-7e_'A Wa te <br /> Street <br /> V kr9ject Code: <br /> Street Address:VO S-H-H94 MOvW <br /> t:-:'..".1' gU 'APt: <br /> City,State,Zip-,P+ Sampler(s). Orw;ck (/4& <br /> IZN I .. xl' P , - . (I P65 1:� _G/_ Wei Is I '?_Ij <br /> Phone�,,SGA IX 111,11...... hi OT <br /> 1-cklt Far. <br /> a pie Matrix > Are there any tests with holding times less than <br /> equal a <br /> 'rx 0-n P. .�d' . . 0 <br /> m DO = ye <br /> Email Address: 1,&6AUf -a or It 48 he rs9 <br /> No <br /> Submittal#: <br /> Standard Turnaround=15 work days <br /> TZ.) <br /> H <br /> 2 C Other Notes <br /> x <br /> "IF <br /> 2— ZIC YAO X_ 1 073(Q <br /> V 14 <br /> Wei I* I.I jA 1 1 ()74� -)L <br /> We 1 C'Otl+ 1 ?60 <br /> 04-A 1.1,00.tt X —_ <br /> c <br /> IJAA rf Ffit"t <br /> —7 <br /> ❑ <br /> vcet 04 p I e te <br /> ell 1 ' X 10 <br /> E`- <br /> Report Drinking Sample Disposal Special Reporting <br /> Same as above 0 Return to Client Disposal by lab 0 OC E] wip E]Flow Data <br /> Waters on State Form? 0 Archive: Months—_ <br /> C lent: r-Or 4A,-J L-6�a 1. Relinquished Date Time �1. Received ID t Time <br /> fi F]Yes No <br /> , , '7 <br /> Address: (A T9 41 ALs 4,-n RA --———— — 71 P011104 <br /> Send Copy to State of <br /> 2_Re_HVqJtsheN By I Date Time 2�r!�� ed By Date Time <br /> 10b <br /> City: 94:t-r C State (A Zip JS33� <br /> CA? <br /> Attn: I-If Yes El No 3. Relinquished By Date 'Time 3. Recdved By Date Time <br /> PO#: <br /> lid'Laboratories,Inc.-4100 Atlas Cf.-Baker4fi-eld,CA 93308-661.327.4911-Far. 661.327,1918-www.bclabs.com <br />