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j CHAIN OF CUSTODY RECORD I BC Log Number �� <br /> Client name 6s r Projector POfi r f Analyses required f <br /> 01 tN <br /> AddressIt�t( ��( Phone ��l�2 y, � <br /> t' 7 �(f <br /> City,State,Zip Report attention II ff o eo <br /> Sampled by <br /> Lab S • I S mw Number <br /> Semple Date Time See key of <br /> number sampled sampled below Sample description containers G4 "V byRemarks <br /> 3:0 0 <br /> 2 :00 AT ') <br /> (Z'as QTR �O <br /> 1120 f� <br /> k <br /> Signature Print Name Company Date Time a <br /> Relinquished byLila n <br /> Received by <br /> Relinquished by <br /> Received fly <br /> Relinquished by _. <br /> Received by La bore C — � <br /> B OWN AND CA WELL LAB RATORIES NOW <br /> 1255 Powell Street,Emeryville,CA 94808 (415)428-2300 Samples are discarded 30 days after results are reported unless other arrangements are made. i <br /> Hazardous samples will be rgturned to client or disposed of at client expense. <br /> 373 South Fair Oaks Avenue,Pasadena,CA 91105 (818)795.7553 r <br /> ❑ 1200 Paclflco Avenue,Anaheim,CA 92805 'KEY. AO—Aqueous NA—Nonaqueous SL—Sludge GW—Groundwater SO--Soil OT—Other PE—Petroleum <br />