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Laboratories, Inc. Chain of Custody Form <br /> Report TO: I I <br /> i-eA'Ve <br /> Client: Prqiect#: 0,Q-C;'j(j4y 04 —1 3 Page J— of <br /> Attn: Project Name: Akc-'C Comments: <br /> Street Address: 350)() ra-l-) 6- Global ID#: S'3 CD F <br /> City,State,Zip:560-r, Ltke, qj,61 Sampler(s): - <br /> AD F 1, J kJ <br /> Phone:, 0AZ� Fax: <br /> Sample Matrix Are there any tests with holding times less than <br /> Email Address:'J'k-I r-k or equal to 48 hours? <br /> _j <br /> Work Order#: Yes El No <br /> C) <br /> *Standard Turnaround=10 work days <br /> C' <br /> Ld Q I V),7Z V91 U�c2Z Q U'� Other Notes <br /> TH-1 417110 0�31DS r <br /> &q 06 L S 0" -L, <br /> 2 3 J <br /> _3 TH-4- <br /> Lj ITI-5 J_LLL i 1,0.5 <br /> 5 <br /> I I I 133i <br /> TH <br /> TH <br /> - 10 TH-I <br /> Same as above EDF Required? Global I System# <br /> (Needed for EDF) (Needed for EDT) <br /> Client: L Ryf�quislied W. <br /> X Patv <br /> Yes El No Time 1. Received By Date Time <br /> _)O " .-2 , <br /> Q <br /> Address: <br /> Send Copy to State of 2. Relinquished y Date Time 2. Received By Date Time <br /> City: State Zip CA?(EDT) &.4 9ki-a �i%o -'�U 0490 <br /> Attn: 1:1 Yes JKNo 3. Relinquished Date Time 1, Received By Date Time <br /> PO#: I <br /> BC Laboratories, Inc.-4100 Atlas Ct.-Bakersfield, CA 93308-661.327.4911 -Fax: 661.327.1918-www.bclabs.com <br />