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t <br /> t <br /> k <br /> CHAIN OF CUSTODY RECORD i <br /> CkeRl nems ? BGA log Numbef - <br /> V Afoject or POr ✓ <br /> p 7✓ <br /> Address Analyses required <br /> cy, Phona69/6) y -o/ <br /> City,State,Zip Repoli altenbon <br /> SQ�q C q6Aeae <br /> Sam f F'! SOiI 41, <br /> `gs <br /> Lab'i Type• p ed W —� Y F <br /> Sample date Time See key Humber Number <br /> sampled Pled below of <br /> _- <br /> Sample description containers € .• ! <br /> �7/�♦' f h Remarks <br /> j <br /> rl <br /> 7:2o G lr/ CIC�7 § l <br /> Asx: <br /> fA <br /> EE-1-F- <br /> ' - S•Ign81UfB <br /> Print Name <br /> Relinquishyd by Company pale <br /> rTine <br /> Received b /' <br /> y CQl 4 z/,y <br /> Relinquished by <br /> D <br /> Received by <br /> Relinquohed by r <br /> RecrIYW by Laborato <br /> B C ANALYTICAL <br /> Nole:Samples are discarded 30 days after results are r:-led unless olher arrangements are made - <br /> _. - •❑1255 Powell Street.Emeryville,CA 94608 (415)426.23{1(1 Hazardous samples wit,be relume..la Grenl w des 'KEY, �—aqueous NA—Nonagii6aus SL-5'ursgv <br /> posed of at client's expense. <br /> •�601 Western Avenue,Glendale.CA 91201 (818)247.57_+7 Disposalarrangements: GW—Groundwalef SO—Sod O1--gihcr A[—Petrolkun. <br /> . 0 12M Panlico Avenue.Anaheim,CA 92805 (71419M-01 13 ' <br /> i <br /> . 1 <br />