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CHAIN OF CUSTODY RECORD BCA Log Number <br /> Client name Project or PON Analyses required <br /> Address <br /> Phone N P30V <br /> 7Fdate <br /> EIVE <br /> .E.S.Ti. <br /> city,Stale Zip Report attentioncper- Q + <br /> Sampled b � <br /> Lab Type L"LE Number <br /> Sample Date Time See key f of �� <br /> number sampled sampled below Sample description containers c�� Remarks <br /> L:>--)L 4-orwz-lTi W <br /> CZII�J-74�--; <br /> 1 C442 <br /> p <br /> Signature Print Name Company Date Time <br /> Relinquis <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by i <br /> i <br /> Received by Laboratory s <br /> B C ANALYTICAL Note:Samples are discarded 30 days alter results are reported unless other arrangements are made. 'KEY: WW--Wastewater SU—Surface Wale( SO—Soil <br /> 4 Hazardous samples will be returned to client or disposed of at client's expense. SL--Sludge PE—Petroleum OT--01her <br /> ❑ 1255 Powell Street,Emeryville,CA 94608 (510)4282300 <br /> ❑ 801 Western Avenue,Glendale,CA 91201 (818)247.5737 Disposal arrangemenls: NA—Nonaqueous GW—Groundwater AO—Aqueous <br /> ❑ t200 Gene Way,Anaheim,,CA 92805 (714)978-01113 <br /> ty <br /> .J L....� ✓11..., i �i.�...� i......� ir......J -,>� L..J L-1 ri,... J I.j <br /> r <br />