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CHAIN OF CUSTODY RECORD SC LOG NO. <br /> Client name Job number Analyses required <br /> 5` <br /> Project name <br /> S <br /> Project manager Sampferlel �e `� <br /> �Q a\`cA <br /> Type <br /> Semple Date Time Composite Number <br /> number sampled sampled or Sample description of tio`b��� Remarks <br /> Grab containers 20 yQ <br /> 11-F <br /> Signature Company Date Time <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> BROWN AND CALDWELL Analytics! Laboratories Note: Samples are discarded 30 days after results aro reported <br /> ❑ 1255 Powell Street, Emeryville, CA 94608 14151 428.2300 unless other arrangements ere made. <br /> ❑ 373 South Fair Oaks Avenue, Pasadena, CA 91105 (213) 681-4655 Hazardous samples will be returned to client or disposed <br /> of at client expense. <br />