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Laboratories, Inc. Chain of Custody Form <br /> Repoil To: <br /> Client: Page--2-1- of <br /> Attn: NA V 1 1 r k Project Name: Aeevu'k Pekoc'-r Comments: <br /> ' 4RiO;L 6_� W C-ulkC <br /> Street Address: Aj .44 Global 5STOZ35 4- <br /> Ciy'State,Zip: lft4l L4"L--- C-4G Sampler(s): <br /> Phone: <br /> 530 <br /> Sample Matrix Are there any tests with holding times less than <br /> Email Address: dkirka. W ci c,co 73 or equal to 48 hours? <br /> Work Order#: s El No <br /> \A <br /> Standard Turnaround=10 work days <br /> 4pw <br /> a 0 V1 <br /> Ln 0 Other Notpp <br /> HK BY Q 1, <br /> 1104. <br /> 11 B-OUT =1 <br /> ag- 134-1 A <br /> 0 RT I E� <br /> CA-2-1 o(15 0 2 3 <br /> D <br /> D AO <br /> C <br /> CA-M- <br /> 09-215 <br /> 0-14-1 <br /> 6 9 7,42 0 . L <br /> Same as above EDF Required? Global ID systeln# <br /> (Needed for EDF) (Needed for EDT) <br /> Ment: Yes ❑No I. 7,1Pquished Date Time 1. Received By Date Time <br /> address: <br /> Send Copy to State of 2. Relinquished By Date Time 2. Received ByTime <br />�ity: State—Zip CA?(EDT) P- 4", 4. -le) �2"1,Q2'. ]%jC217-1 2- <br /> Wn: EI Yes XNo 3. Relinquished Dale Time C—I—RVE—eived By DAte Time <br />?0#: <br /> BC Laboratories, Inc.-4100 Atlas Ct.-Bakersfield, CA 93308-661.327.4911-Fax: 661.327.1918-www.bclabs.com <br />