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I <br /> BCA Log Number <br /> CHAIN OF CUSTODY RECORD <br /> Prvjed or POR .5/7,3 <br /> /7 3 <br /> Analyses required - E <br /> - CFont name ." � /5v p _ <br /> Phicne <br /> - Address � � S' S <br /> ae <br /> City,State,Zip �+A {✓�r Repon allention �y S �F`sp gcI'a C�ff r S�.eu y c I i�isar �g <br /> Sampled by -�c ~ r <br /> Tom- 5i Q%$ I d4 Number <br /> Lab Of ti <br /> Sample Date Time See key Containers y Rnmark4 <br /> number sampk3 sampled below Sample description J - <br /> V <br /> 11 7• G w it � <br /> It 7:20 G W <br /> i <br /> r - <br /> .'y <br /> �r <br /> Print Name Company <br /> Date Time <br /> Signature <br /> Relinquished by Tan JA CR r T l <br /> Y, <br /> Recelved by <br /> Relinquished bti <br /> Received by <br /> Relinquished by _ <br /> ori <br /> RpCaiod by Lahore! ! <br /> c..r. <br /> idge <br /> .• C p�ALY4��L _ `Nolo:Samples are discarded 3Q days apes resuhs are repa-1etl unless other arrangements are made, N�A Oundwa us SOA$Uil v OT-0111101 e LPE51 Pelro'eum <br /> Hazardous samples will be returned t°client or disposed of at client's e><perse- <br /> •0 1255 Powell Street.Emeryville.CA 94508 (415)420-2300 Disposal a+raemcnts: <br /> .[38411 Western Avenue,Glendalrr,G+81201 181B)247-5737 ' <br /> 1200 Pacifica Avenue,Anaheim,CA 921305 (711197&0113 - ' <br />