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Laboratories,Inc. Chain of Custody Form <br /> Repon To., I Page o <br /> client: . 14 C— Project#: <br /> cl f <br /> 9 <br /> Comments: <br /> Attn. tym t(DAt4tid Project Name:ACICC VM S. 11 = Aglpt I-led WA-kv <br /> Street Address: Global ID <br /> UP <br /> Cit q Sam pler(S): &VA 7-VjAL11Ka <br /> Y,State,Zip:',_�tk�a�leez <br /> Phone: AA ko Vo V <br /> 06 01'�q TO Fax:W-174.1 <br /> 419 Mai IQJ Sample Matrix A-thereany tests Vth holding timers less than <br /> Email Address., e•kvl r%(_dUeV_*i&.M.A_4s�C41- or eqw�l to 48 hours? <br /> Yes <br /> Work Order An <br /> BrStandard Turm1round 10 work days <br /> E. <br /> Other Notes <br /> (),I 1 11111 16cl <br /> ICIA- I L <br /> e4l 'D U'P t <br /> I I <br /> C . <br /> X Di <br /> 1 W�211 #Z-1CYA-*-2— <br /> I <br /> "DI <br /> FFT <br /> r r- <br /> OP <br /> 101,T_0 <br /> SS <br /> ---.q T <br /> DO BOD MAS C <br /> Special teporting <br /> F1 Same as above EDF Required? Sample Disposal <br /> A� El oc El E 1 <br /> Disposal by lab -cbNe: Months F EJRaw Data <br /> ❑ Return to client <br /> F-1 yes No <br /> um'YA LaoRd I. Relinquished By Date Time 1. Receiyed By <br /> Date Time X <br /> Address: --------- <br /> City: KA al-Ab?CA State CA?(EDT) <br /> Send Copy to State of 2. Relinquished By D <br /> Attn: NvObtv I Time - <br /> V1_ J Cav 6a,' 3. Relinquisbed By Date! Time 3. Received By Date Time <br /> .PO#: X"Yes El No I I I <br /> BIC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911 -Fax: 661.327.1918-www.bclabs.com <br />