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AFC LABORATORIES , INC . Chain of Custody Form <br /> Report To: <br /> Client: Project #: M Page of <br /> Attn : Project Name: Comments : <br /> Street Address; <br /> City, State, Zip: , , fir. Sampler(s) : <br /> Phone: Fax: <br /> Sample Matrix Result Request **Surcharge <br /> Email : <br /> Work Order #: o ❑ STD E] 5 Day" E] 2 Day" ❑ 1 Day" <br /> -Errv (Mays) <br /> DQ, C C d <br /> SampleDescription *0 <br /> ' ' ' ccc Fn 0 09 Other Notes <br /> • Same as above EDF Required ? Global ID System # <br /> Geotracker (Needed for EDF) (Needed for EDT) <br /> Client: Yes EJ No 1 . Relinquished By Date Time 1 . Received By Date Time <br /> ❑ <br /> Address: <br /> Send Copy to 2. Relinquished By Date Time 2. Received By Date Time <br /> City: State Zip State of CA? (EDT) <br /> Attn: ❑ Yes ❑ No 3, Relinquished 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 v32701918 — www. bclabs . com <br /> :i <br /> ii <br /> f . <br />