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CHAIN OF CUSTODY RECORD <br /> Client name C <br /> v� BCA Log Number <br /> [Phone <br /> ect or PON 6� Analyses required <br /> Address N <br /> Lp <br /> a�e� do V� dip <br /> City State Zip Q Report attention <br /> T, e. <br /> Lab Sampled by <br /> y 'ri ace <br /> Number r <br /> Sample Date Time Sea keof <br /> number sampled sampled below <br /> Sample description Remarks <br /> ,f <br /> A <br /> I <br /> *�>34, <br /> "P YA x <br /> x <br /> $ t X <br /> ZMC� Li I <br /> ature Print NameCompany Date Tim, <br /> Relinquished by 4 <br /> it Li cp_ <br /> Received by <br /> Rerinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory <br /> B C ANALYTICAL Note Samples are discarded 30 days atter results are reported unless other arrangements are made KEY AG—Aqueous NA—Nonaqueous St_—Siudge <br /> ❑1085 Shary Circle Concord CA 94518(510)825 3894 Hazardous samples will be returned to client or disposed of at client s expense <br /> GW—Groundwater 50—Soil PE—Petroleum <br /> ❑801 Western Avenue lendale CA 91201 (818)247 5737 Disposal arrangements <br /> ❑Awne At 11M 928M)978-_ _ <br /> M <br />