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Laboratories,Inc. Chain of Custodyr <br /> rsrpo,���: + • . - . pale 1 of <br /> t S S !-, G, —Project#: <br /> -------_' <br /> Cllent:l r.a• - Comments:Attn Dat ' - Project Name YGG m .• in <br /> Street Address: S; F Global ID#: w c.An ,,. t 3b �:t la ;; `t. .1 �t !J rd�i t 2.�'.� �4/tr 'Pr <br /> Cit State Zi t:St.Cjaba04 Sam ler s :0tv,d 1)"4q <br /> ell <br /> I'ltone&36- I l'ax: n m <br /> Are teay tests with holding times less than <br /> Sample Matrix <br /> or equal to 48 boatel <br /> ]Entail AddreSs:dird�,r u�C� (`�1 - o 3 ro o o ❑Yes No <br /> Work Order#: p *standard Turnaround=10 work days <br /> it . <br /> 0 In C Other Notes <br /> c-Ve 2- Z S. 1315 <br /> F8 0 �� 1333 ` D �- <br /> �/ 1 �, 4 )310134o Y <br /> x <br /> BG T el oo r f' ,A<e 1 too : <br /> Ln t�a�- vie U <br /> jr ZS4j VIA <br /> 6H l a3u,'"101 <br /> Sample Disposal Special Reporting <br /> + i-TTLL L'❑ Same as above EDF Required? ❑QC ❑EmF 11 Raw Data <br /> q /t ❑ Return to Client Disposal by lab ❑ Archive: Mnntits <br /> Of i/1�61rC'� Lwn�'�tI1 �( . 1. Re gttishedi3,y Date Time 1. Received By �� �� Time <br /> C.lent, ❑Yes No 2 <br /> s .� -, z s a� is <br /> Address: Send <br /> op to ._! Date Time 2. Received Sy Date Time <br /> Send Copy to State of 2. Rehngutshed By �� <br /> City: �, VACA _ State Zip CA?(EDT) �` � <br /> Attn: cA e-l' `A� <br /> k <br /> Yes 3. Relinquishedicy Date Time 3. Received Sy Date Time <br /> L"�__._-- ElNo <br /> PO#: r...r. <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield, CA 93308-661.327.4911-Fax: 661.327.1918-www.bclabs.co.m <br />