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s <br /> "boratorles Anc. Chain of Custody Form <br /> f ft <br /> RV-1f To: j k i d <br /> Chent: 1 cw L-� 6 t ',, Pro'ect Pae _of _. <br /> Comments <br /> Project FAttn aie: <br /> 0; <br /> Street Address:411 jr •: 14; 1 IJ, obal ID#: <br /> Ciy,State Zip IV',- tt.t c s ' tn!?s$'gym ler S { c{�l �:H! a ^_. r �y E it -i r t <br /> Phone: <br /> d r <br /> Are h than <br /> s <br /> _• � � "'ere s tea a vritfi hotdtng Mmes Ieas <br /> T �.. Sample Matrix a° t <br /> ,. s or equal to 48 Lours? <br /> Email Address: y b <br /> t~ <br /> a. s ' ❑Yes NO <br /> Work Order#. -a.�. C M:, t_1� 3 p <br /> w.? w 3 *Standard Turnaround= 10 workdays <br /> (A Vi Q 0 3 Other � Notes <br /> i:zv <br /> - f.JSa7 4'� <br /> IjCfrM1� '� £J!n 1 Via` =.f jXy <br /> `� <br /> A' <br /> 4^k] ,aF 'F" [ .. 9` ^T�r • <br /> 17 <br /> ,i,.� {M �,`; ° ��e.�,5w 1 ,r?A 2 �S°'.,•,,' <br /> 3 P :M:it <br /> EDF Regntr�ed? [Gahm 11)Same as above (` MY, <br /> ¢ � <br /> ;.•sett for int'' - ( 'zr'si am Fp,r, <br /> Date' t Time 1. Received B Date;, ITimeClie t: shed i }r1 f ❑Yes 4 *NoAAddress: 'r` __ —— Date t ee"rSend Copy to State of tiijni5hcd'Ry a e ame 2. Rec t i !Cita: --�t _Stage '�Zip K. Cn?( T) 2 Re D �• mAttn' � ` { { t " ❑No 3. Relinquished By, Da£e Time 3. iteceived IlyDate <br /> _ [ 'es <br /> PO#: <br /> BC Laboratories,Inc.-4100 Atlas Ct. -BaXersfield, CA.93308-661.327.4911 -Fax: 661.327.1918-www.bclabs.com <br /> � y <br />