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PLEA OMPLETE ,. <br /> AL> Laboratories,Inc. Chain of Custody Form HCL QUOTE ID <br /> 46012E z <br /> ReponTo � ; a a Pae--,—/ of <br /> Client -7;Z-_ P .ect# ivsxcxY g <br /> Attn Z/ s Pro ect Name Comments' •7��g s F -�� <br /> /I <br /> Street Address- Pro ect Cade /{ , t' tib to lie ba k( ti i <br /> g <br /> City,State Zip Sampler(s) Z?6j-ShLeeAt �ge or f)I P1, tiRfiwC�l I+ i, <br /> Phone me - 5/ Fax as 3-aiJi cQltr,i�(f Te�Cr7,�C} z9 I� t U do�h `,Il£ It21 ttat d �'��rL_ <br /> Sample Matrix Are there any tests with holding times less than <br /> Email Address •! o it ZSb 7XC,01 or equal to 48 hoars7 <br /> m m v o ❑ Yes ❑ No <br /> Submittal# 3 3 E o *Standard Turnaround=15 work days <br /> Sample Descriptioncr a r v o H o <br /> � 4 R <br /> Sampled Sampled Ln V)A C7 3 Other Notes <br /> Y)U1 I I I <br /> L CrfiS w c c_ <br /> 5 <br /> un <br /> Report DnnlSample Disposal Special Reporting <br /> Same as above p g ❑ <br /> Waters on State Form7 1:1 Return to Client ❑ Disposal by lab Archive Months_______ QC WIP ❑ Raw Data <br /> C{lent ❑Yes ❑No I Relmqu ed Date Time 1 Recei Date Time <br /> Address ————— x'16165_ /5- <br /> Send Copy to State of 2 Re m uishe gy Da Tame 2 e eived a at Time <br /> City State Zip CA, U <br /> Atta. El Yes ❑NO 3 R shed t Dam Time 3 erved By Date Time <br /> Po# <br /> Off _0 1 <br /> BC Laboratories,Inc --4100 Atlas 0 -Bakersfield, ,-66l 7 4911-Fax 661327191 8-www bclabs coin <br />