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CHAIN OF CUSTODY RECORD 1 C: SCA Log Number <br /> l <br /> Client name Project or PO# Analyses required <br /> k sgr-as <br /> Addre s P one# <br /> X01 e(, mil <br /> s <br /> City, tate,Zip Report attention �e <br /> WN T (L- <br /> Q <br /> Lab Type Sampled by Number <br /> Sample Date Time See key �"t of op K a u <br /> number sampled sampled below Sample description containers ��g� Remarks <br /> O)WA 0.31-Lo 122 <br /> 1004 <br /> t4 O4 —03 <br /> w•y O5� <br /> Signature Print Name Company Date Time <br /> Relinquished by \ 4k (�(., <br /> Received by -W <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory / 1wv&\etie. WooA vjv m-,l— h`c 0 l o a <br /> B C ANALYTICAL Note Samples are discarded 30 days after results are reported unless other arrangements are made 'KEY AO—Aqueous NA—Nonaqueous 5L—Sludge <br /> ❑1085 Shary Circle Concord CA 94518(510)825-3894 Hazardous samples will be returned to client or disposed of at client s expense GW—Groundwater SO--Sod PE---Petroleum <br /> WW—Wastewater <br /> ❑801 Western Avenue Glendale CA 91201 18181247 5737 Disposal arrangements <br /> ❑1200 Gene Autry Way Anaheim CA 92805(714)978-0113 <br />