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CHAIN OF CUSTODY RECORD <br /> BCA Log Number <br /> Client name Project or POk <br /> 1 / Analyses required <br /> Address Phone N <br /> �- •P Sas mss` - z z ti° <br /> City,State,Zip Report attention <br /> 4 <br /> Lab Type• Sampled by <br /> Number ? <br /> Sample Date Time See key of n ''1CC ,�'�0� <br /> number Sampled sampled below Sample description containers gQ Remarks <br /> gglI <br /> G�7*11 11,24 <br /> Signature Print Name Company Date Time <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by IMF <br /> Received by Laborato ��nie - I A14 <br /> B C ANALYTICAL Note:Samples are discarded 30 days after results are reported unfess other arrangements are made. 'KEY: AO—Aqueous NA—Nonaqueous SL—Sludge <br /> 0 1255 Powell Street,Emeryville,CA 94608 (C28-2300 Hazardous samples will be returned to client or disposed of at client's expense. GW—Groundwater SO—Soil OT—Other PE—Petroleum <br /> ❑ 1255 Powell Street,Emeryville,CA 94608 ( 28-2300 <br /> ❑801 Western Avenue,Glendale,CA 91201 (818)247-5737 Disposal arrangements: <br /> 0 1200 Pacifico Avenue.Anaheim,CA 92805 (714)978-0113 <br />