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M M =1 � M M ! i M M M M M M M M M <br /> �BC�* Laboratories,Inc. Chain of Custody Form 13(A," Etj <br /> Repon 7o: 57298 <br /> Client: 5 So Ci Q PS 6. Pro'ect#: `�"+" AnalysisRequested Page._.....—of <br /> Attn: s '�, P Pro'ect Name: G G VO(, Comments: <br /> Street Address: 30 S, 1"1 �i i�t�t Project Code: ""�" , , ;�, FQb�Ex Ttuc�Cr° �c� �' = 800��✓��L^�� <br /> City,State Zi , (1u6ft 6.3 Sampler(s): <br /> Phone: - 3 '-�/lf1 Fax-6J6 3qj 15 c, Gra r , I qui." . x ,. D.1.. �7�ion�3.zcp U✓<at�r' <br /> (f�f��,�,� Sample Matrix Are there any lents with hoiding times less than <br /> Email Address:4&6- �ltP/5 oaf C"�f!t�f M N .; y y D y or egoai to as hour <br /> tap <br /> s ❑ Yes No <br /> Submittal#: 3 3 o <br /> Sample Description <br /> . • a Standard Turnaround=15 work days <br /> Date <br /> Sampled ° ` Notes <br /> V)rn R 0 3 Other <br /> 2 Wet *12 4m ii 2. . Iv ! 7 . <br /> 3 F`ea k.,A e 1 c W4 /( 1,07 M35 X/ <br /> 9 4 14 1 Il 0 0 950 ,X <br /> 5 Pi-eld Pi-eRIA.4k In yr 4iic. k fc 111 107 j0 OS .X D:r <br /> 6 e for r ct°+ ti 18 1,07 d( 5 " "A <br /> 7 f0 111-107 /015 .X <br /> #A b 18UTCN <br /> I IC <br /> 5L 13- <br /> ® Report Drinking Sample Disposal Special Reporting <br /> ❑ Same as above ❑ Qc 0 WIP E] Raw Data <br /> Waters on Stale Form? ❑ Return to Client: Disposal by lab ❑ Archive: Monihs_________ <br /> Client: A k-11F-1 YesXNo 1' myDate Time 1. Reeeiv By Date Time <br /> a `� S. f { _ _ -.�---�lc u v 10�00 � EX I-oil(V4 1 <br /> Address: 5 ———— <br /> /� Send Copy to State of 2. Relinyuished By Date Time Re ived B Date Time <br /> City: t^/ 'tlast±eC(A State(A Zip �S3'3 CA, (� <br /> Attn: �~' i ����� ❑No 3. Relinquished By Date Time 3. Received B Date Time <br /> Yes <br /> PO#: <br /> BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911-Fax:66.1.327.1918-www.bclabs.com <br />