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S b It�Mcvl <br /> /0 <br /> (0 F{(�f f , 2)3J �HAIN OF CUSTODY RECORD " �� er 9 <br /> BCA Log Number <br /> Client name r �9 prefeet-eFiZ L Z f 53-1 3—S Analyses required <br /> Addres CO-%J� hone#J,- <br /> 161G, M c a-+ 4ce 9IG1 Y��-dl Z� <br /> Crly State Zip Report attention <br /> S a c .Q I e.,,, 9 S 13 Sfe N1 r S 44-e v- <br /> T Sampled by //JJ <br /> Lab -Y� � 'LLQ! Number <br /> Sample nate Time See key of �a <br /> number sampled sampled below contamers r�<! ��� <br /> Sample descnpilon Z 5 Remarks <br /> Lf fi r <br /> 31 l to -(,o- <br /> 7 <br /> o- Ca s <br /> 71 <br /> 6 r2,u s-sem/01 r <br /> 7 12 32- S-,SCS i.5- <br /> /9' 'V <br /> ly'V V-S@ td l 1 <br /> I <br /> v -SQ Is- ' 1 X\ l <br /> Signature q f Print Name /w Company Date Time <br /> Relinquished by if'Jt C ,I (t Q A, L. C Ca N i ie a l <br /> 3 <br /> Received by c�, & <br /> Relinquished by <br /> Received by !J `c <br /> r �' �vfr] 3 r LS'rJ <br /> Relinquished by �� � - -- //r S`.f�rrb11c)II ) q 2 Z_ <br /> Received by Laboral°Cy � ynVI w es r" it � ' <br /> \ <br /> B C ANALYTICAL Note Samples are discarded 30 days atter results are reported unless other arrangements are made KEY WW—Wastewator SU—Surface Water SO—Soil <br /> Hazardous samples will be returned to client or disposed of at client s expense Sl.—Sludge PE—PC110leUm OT—011ier <br /> ❑ 1255 Powe real EmerPilt 94608 {510)428 2300 <br /> ❑ 801 Western�Aven dale CA 91201 (918)247 5797 <br /> Disposal arrangements NA—Nonaqueous GW—Groundwater AQ--Aqueous <br /> 1200 Gene AAoahei 805 (714}978 0113 <br />