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CHAIN OF CUSTODY RECORD <br /> - <br /> Client name <br /> Prateci or POM Analyses regtinreU I <br /> Addressu <br /> Phone M (' <br /> City,Stale,Zip Report attention <br /> T ' Sampled by <br /> Lab _Y�.e,_ c Number <br /> Sample pale Time See key �� of <br /> number sampled Sampled below Sample description containers l' 29gQ¢ Remarks ` <br /> J C� r G' , T! -- <br /> D 111"3 _ Y `7 <br /> 1 � <br /> PfA C) <br /> y - x -- <br /> x <br /> Signature Print Name Company Date Timt <br /> Relinquished by. I'l ta nce-Lmja R)� on n <br /> Received by C <br /> i <br /> Relinquished by <br /> Received by —1 " <br /> Relinquished by <br /> Received by Laboratory <br /> BROWN AND CALDWELL LABORATORIES Note: ? <br /> ❑1255 Powell Street,Emeryville,CA 94808 (415)428-2300 Samples are discarded 30 days after results are reported unless other arrangements are made <br /> ❑ <br /> 373 South Fair Oaks Avenue,Pasadena,CA 105 <br /> Hazardous samples will be returned to client or disposed of at client expense.91. (818)795.7553 <br /> ❑ 1200 Pacllico Avenue,Anaheim,CA 92805 'KEY: AQ--Aqueous NA—Nonaqueous SI.—Sludge GW—Groundwaler SO—Soil OY—Other PE—Potroruum <br />