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• CHAIN OF CUSTODY RECORD f.:� _ � j`fn �] (�q�//__ qSn�� BGA Log Number <br /> �P <br /> Client name n Project or PO# Analyses required <br /> Address Phone# <br /> 3 a �il,�� Sis✓> Y3� /v r �� <br /> City State Report attention 1 1 :l <br /> .4s Q o� <br /> G <br /> f_i_ to IL�ri G t (}1 om� �c <br /> Sampled by _ tea <br /> Lab Type' �l�,�AR ooar`° <br /> a � <br /> ample Cate Time See key Numf bar <br /> � � m <br /> number sampled sampled below Sample description containers `vJ� SmgQ� Remarks <br /> 1 100`l t✓ 1�t,f <br /> 115 U , - u r - l 7 <br /> b-2 k U b - Mw - 1 = <br /> to-3 3 It�a`� - #4 j ,2 <br /> I 132o <br /> "2 1 tot 1009W, AU-) - 5 <br /> (o-zo <br /> (7.10 ov`� <br /> JP &Ajp, 04-rtC4Vd 6124W <br /> i <br /> Sig ature Print Name Company Date Time <br /> Relinquished by <br /> Received by •rte( )�yI 7J <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory Bye v Wn/ sPf!� 3 y <br /> B C ANALYTICAL. Note Samples are discarded 30 days after results are reported unless other arrangements are made "KEY AG—Aqueous NA—Nonaqueous SL—Sludge <br /> ❑1085 Shary Circle Concord CA 94518(510)825-3894 Hazardous samples will be returned to client or disposed of at client s expense GW—Groundwater SO—Sod PE---Petroleum <br /> ❑801 Western Avenue Glendale CA 91201(818)247 5737 disposal arrangements / <br /> ❑1200 Gene Autry Way Anaheim CA 92805(714►978-0113 _ _ _ _ _ __ (x .12-1 <br />