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TBC� <br /> Laboratories,Inc. Chain of Custody Form <br /> Report To. a • _ _ _ <br /> Client: 1 ED Project#: ® ® Pae of <br /> Attn: 0 Project Name- Comments: <br /> Street Address: AlkGlobal ID : P,ea a_ 3 d e o bz b'a A 1, _S <br /> City,State Zi 3 Sampler(s): 1�J egTl or r-o dol Of <br /> Phone: Fax: m r- 6$ I' IU!", II d", qs <br /> Sample Matrix Are there any tests with holding times less than <br /> Email Address: v A e r ",r ti b or equal to 48 hours? <br /> Work'Order#: —V 7 Elves ElNo <br /> C b O <br /> *Standard Turnaround=10 work days <br /> • •�- • <br /> Notes <br /> Other <br /> Other <br /> 4 <br /> d <br /> 100- <br /> V <br /> MBDSame as above EDF Required? Global ID System# <br /> ( eeded for EDF) tuuu-bqzrq6t (Needed for EDT) <br /> Client: Yes O 1. a inqui e D to Time 1. Received By Date Time <br /> Address: C- t�, <br /> Send Copy to State of 2. eh quishe Da Time 2. Received By DateJA' Time <br /> City: State Zip CA?(EDT) <br /> Attn: ❑Yes O 3. Relinquishedlkv Date Time 3. Recei46d By Date Time-- <br /> PO : <br /> BC Laboratories, Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911 -Fax: 661.327.1918-www.bclabs.com <br />