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1E>1 <br /> Laboratories, Inc. Chain of Custody Form <br /> ropnn r,: � _ <br /> Client: � ) V FCW�9 Project#: F Pae of <br /> Atttl: �r Project Name Comments: <br /> Street Address: 7n Global ID#: ( ,. <br /> C•t &te,Zi , t( Sampler(s): <br /> P one 5 �34;ax: DO <br /> Sample MatrixAre there any tests pith holding times less than <br /> Email Address: or equal to 48 hours? <br /> Work Order#: `-C�' �� � y� ❑ Yes No — <br /> ® _ it, Pi <br /> e • ®, �, v 1E_' Standard Turnaround'=10 work days <br /> : Fa <br /> e a a e °n —n)a Q) Other 4k Notes <br /> 1-10 <br /> )r i] l <br /> e a Same as above EDF Required? Global 1D 5ystcnl# <br /> (Needed For EM t Needed fo-FDT) <br /> Client: yes NO J Relinquished B Date ( Tim <br /> e <br /> 1. Received By Date Time <br /> Address: <br /> Send Copy to State of Relingnishe IIy Date 'rime 2. Rec ive y Dale 'rime <br /> City: Stake Zip CA?(EDT) <br /> Attn: ❑Yes ❑No 3. Relinquished By Date Time 3. Received By Date Time <br /> PO#: <br /> BC Laboratories, Inc.-4100 Atlas Ct.-Bakersfield, CA 93308-661.327.491.1 -Fax: 661.327.1918-www.bclabs.com <br />