Laserfiche WebLink
w Chain of Custody Form �` E�oTF_16 :` <br /> Laboratories, Inc. $Ct pUn ,a .. .. <br /> Rrpon To: <br /> Client: TiF R Vk A VAC Project#: -03 Is IR - .42300 Page of <br /> Attn: TO N'? l.a L Project Name: bCC �' Comments: <br /> Street Address: Q o'ect Code: a SE��J�GC <br /> Ci State Zi :&A V- Samplers : 1d c'ge or` '0 i.=� t (1al 1 O.3 55 507 -�j 3913 <br /> PltoQ :�7 32U.Fax.-Sb -7277.5it 1-U [k) is ' 12 III ht ' <br /> EmailAddress: Yda �( %a C e co q i!ge d. Sample Matrix �. are there any tests with holding limes less than <br /> .. �^ or equal l0 48 hou <br /> Submittal#: 1 y <br /> 3 m u o� Yes No <br /> S i.e _ on Date scrN (} 3 E?o *Standard Turnaround= 15 workdays <br /> o R <br /> Time <br /> Sampled Sampi ' ,Z A c7 3 Other % Notes <br /> 11309' "A x <br /> Report Drinking Sample Disposal Special Reporting <br /> Same as above ' ❑ oc ❑ WIP E] Raw Data <br /> Waterson Stale Form? Return to Client Disposal by!ab ❑ Archive: Months_�_�__ <br /> Client: ❑No 1, wsihed By. Date Tim <br /> El Yes e 1. R ved By Date Time bc <br /> Address _- _.- ———__ /"'lt 0 I V. a 0 <br /> Send Copy to State of 2• inquished By Date Time 2. Received By Dale Time <br /> City: State Zip CA? jta d Spig <br /> Attn: El Yes ❑No3. Relinquished By Date -me <br /> It ived ai Time <br />� PO#: <br /> iBC I aboratories,Inc.-4100 Atlas Cr.-Bakers 3308-661.327.4911-Fax:661.327.1918-www,bclabs.com <br />