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Itc <br /> PLEAS. .UMPLETE: <br /> Laboratories, Inc. Chain of Custody Form 52800 <br /> n (� 13CLOMIT 1r): <br /> Reponr T. _gyp . . , 5 2 8 0 0 .� <br /> Client: rL Project#: i-1wSC.—c'l �"JfJ` FFJJJ Pae of <br /> Page <br /> Attn: , Project Name: C.---- P4,li`, Comments: <br /> Street Address:21 w.-)n,n o l 4 Dz, Project Code: jjjq5 <br /> City,State Zip: `7 7k>I q Sampler(s):(", <br /> vvv H" Ot' <br /> Phone: 341-7Hyu Fax: 763 idly <br /> _ r Are there an tests with holding limes less than <br /> �7 zx� Sample Matrix � r t; <br /> Email Address:q �,nta �c ,s, y, i�}t f� ! �S T or equal to 41;hnurs? <br /> R D <br /> Submittal#: �S 6 Z 9 °� _� 11Yes LlND <br /> X 3 r <br /> Sample Description Date Time 0 <br /> 13 *Standard Turnaround= 15 work days <br /> Sampled 001 . E�5 a 0 3 Other Notes <br /> /�iW- 1 <br /> Nt Uj -( <br /> 19 W-Li I O qL <br /> 25- w -S Il I <br /> Ul 4 1ICU{ <br /> tv- OO <br /> W -Z3 <br /> I(A W Z:L <br /> NAS' -Zu 1009 <br /> - Cg44 <br /> -lW L - q v 032 v . ✓ <br /> F <br /> SRt Drinking Sample Disposal Special Reporting <br /> Same as above Report <br /> Waters on Slate Form? El Return to Client E�isposa]by lab Archive: Months__________ Ll oC 171 WIP 1-1 Raw Data <br /> Client. O c_o i ❑Yes Ll No1. Relinquished By Dale Time 1. Received By ][late Time <br /> Address: ————— Off'���5 1yoG, {t r; .. a�v (9-31 ass /yo­ <br /> Send Copy to State of 2. Roinquis y Dale Time 2. eive y Dat Time <br /> City: State Zip CA. �'� �l-uS l <br /> Attn: Ll No <br /> PO#: 3 nquish Ila][ Time 3. R c Ived By ate Time <br /> ❑Yes <br /> 7 r tJ5 j c <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield, CA 9330 -661. 27.4911-Fax. 661.32 .1918-www.bc n r , <br /> �-1 ��.�->+-�:Nt <br />