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EASEMMOIME <br /> La oratories, Inc. Chain of Cus ody Form p BCLQUO-MD <br /> Repot To �- 36557 <br /> Client R C Pro ect# q!0 5Otr-O)/FIq z o ' Page-2— of <br /> Attn• A n A F Ol I'�M 11 Pro ect Name C o 4o(o Ni l P5 o 71 Q Comments: <br /> Street Address T e(AYE 0 t Ori E Project Code- 5 a = F lei go ilc, Ila k [ i� <br /> City,State Zip, IrY,vie CA 9 Z 618 Sampler(s) VaV, ge Or cal tial tic I <br /> Phone Jqq-3q1-7i1/OFax q41 -753-011 ( Wl 14 :W- TOk'110011% iii tick is °iii( ni flit cl <br /> Email Address fa�fu� �s0 }'`"� Ca., W'1'04,� lu�� TQ�S0t7 � � *�t� 1 Sample Matrix �� Are there any tests with holding times less than <br /> � ore equal to 48 hours <br /> .Submittal O 91±53 3 o ElYesElNo <br /> ` a a <br /> LU O „ 3 *Standard Turnaround=15 work days <br /> rn° L1 i7 3 QtheC 4k Notes <br /> �Lv►r—X15 0$i� <br /> _r r5 Mw-Sp 08/}56 <br /> r1 MW-5 .• 4 V 7 <br /> -- y MW-2 a9l <br /> 11 J 1 54 <br /> r MW45 t7 <br /> Mw-70 1D old <br /> Mw-7$ [OHIO <br /> ❑ Same as above Report Drinking Sample Disposal Special Reporting <br /> p <br /> Waters on State Form 11 Return to Client ❑ Disposal by Months----- <br /> Archive Months -_ [D GIC WiP E] Raw Hata <br /> Cheut ❑Yes ❑No 1 ReMd shed B Date Time 1 Received By Date Time <br /> Address r____ 256 9' �b <br /> Send Copy to State of 2 elingn h Date Tune ei By Date Time <br /> City: State Zip CA, <br /> Attn. ❑Yes ❑No 3elinquished y Date Time 3 eceive Date Time <br /> Po#- - -a z -) -0 a[ <br /> BC Laboratories,Inc -4100 Atlas Ct -Baker eld, 93308-661327 4911-Fax 6613271918-www belabs Am <br />