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BC LABORATORIES , INC . Chain of Custody Form <br /> Repott To: <br /> • ' • Pae of <br /> Client: Project #: 9 <br /> Attn: f, ., , � f ' ! rr Project Name: Comments : <br /> Ir I <br /> Street Address: * <br /> City, State, Zip; Sampler(s): <br /> Phone. Fax: <br /> Sample Matrix Result Request 'Surcharge <br /> Email : . <br /> t. C m lu STD ❑ 5 Day" ❑ 2 Day" ❑ 1 Day" <br /> Work Order # : - 3 3 (10 Days) <br /> • - <br /> Date TimeQ c m <br /> • • • • `u� in 05o c7 Other Notes <br /> i <br /> r� . . IAL <br /> Ll <br /> f <br /> 7Address: same as above EDF Required ? Global ID System # <br /> Geotracker (Needed for EDF) (Needed for EDT) <br /> ❑ Yes ❑ NO1 . Relinquished By Date Time 1 . Received By Date Time <br /> City: State Zip Send Copy to 2. Relinquished By Date Time 2, Received By Date Time <br /> State of CA . (ED'S <br /> Attn: ❑ Yes ❑ Nor <br /> inquished By Date Time 3. Received By Date Time <br /> P. O. #: <br /> BC Laboratories , Inc . — 4100 Atlas Ct. — Bakersfield , CA 93308 — 661 . 327 .4911 — Fax : 661 . 327 . 1918 — www. bclabs . com <br />