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0 <br /> i2so> Laboratories, Inc. Chain of Custody Form PLEASE SID ' <br /> =a t • . - - . 36578 <br /> F <br /> nt: Pra ect#• ulD5cx�c�i P e__l__ of <br /> "l— <br /> : c. r a Pro ect Name.Gxt il, Comments: <br /> Street Address. �{ 1ccF,nUlor 1 Pro ect Code. <br /> Ct state Zt : r u i4 Sampler(s). ge €tt en p i. i <br /> Phone:449 i— 7 �iaFar' 441753- e. ` ra no is , SIE of b-d €� <br /> u r �. Saut�le Matrix . Are there any tests with <br /> 0 48 hong Imes less than <br /> al <br /> Email Address:G Q trc y a oca7 €' ❑ yes ❑ No <br /> Submittal#• I i-11--Z <br /> 7" 3 3 <br /> m c *Standard Tumaround= 15 workdays <br /> ���......JJJ .ti <br /> • --• r d 100 V,iZ 3 Other I Notes <br /> M QI 2 "d i. #e-t- <br /> --14 - S <br /> -S 0`Yo e <br /> - L 90SUE OUT <br /> -'� - <br /> 10 <br /> Aw -I 0 S 1 CRLl S <br /> - 10 <br /> -10 <br /> -3 <br /> �Il M U - �D <br /> V4 <br /> Report Drmlang Sample Disposal Special Reporting <br /> 21's'ame as above <br /> Waters on Stale Farm? ❑ return to Chen! Disposal by lab ❑ Archive Months ❑ QC ❑WIP ❑ Raw Data <br /> Client: Yes ❑NO i Re y ate Time I Receaved By Date Time <br /> 0$-2� <br /> Address: ——---—— <br /> Send Copy to State of Relin n d By Date Time 2 erred Da Time <br /> City: State Zip CA? iz-vs- 1`!0 as i /61d <br /> loam ❑Yes ❑No nq°i8 Date Time 3 ceived By Date Time <br /> Po#: ? z �s 96C) <br /> BC Laboratories,Inc -4100 Atlas Ct --Ba"e4 CA -661 327 4911-F 661327 1918--www bclabs.com <br /> 1117 <br /> �A W141 �9a <br /> r <br />