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Laboratories,Inc. Chain of Custody Form <br /> Repmi To., IP,aLe J—of <br /> Client:.Aelt-k .5 i PrQject#: Comments: <br /> Attn: VA Prqiect Name:hM U <br /> J <br /> Street Address: �U,9�lobal ED#: <br /> P <br /> City,State,Zip: �2�3 Sampler(s):�,y I%41pamyl loct 2. <br /> J 4", <br /> PhoneQN0 4 gill Fax-L%qAjj0 -3than <br /> Sample Matrix Am there any tests with hoiding times less <br /> or equal to 49 hours? <br /> Email Address: CrZ Elyes [--] No <br /> Work Order#: w <br /> , I j d-B; E 3 <br /> standard Turnaround 10 work days <br /> 9 - 90 <br /> Other Notes <br /> 2-3 it-'i Z57(-P D'I <br /> CIA iI ............... <br /> ?2 315, Xc <br /> I C-IA#--> <br /> Ct <br /> 11 V- <br /> Cov '�;L') . ...... <br /> 8A oo v., <br /> UTI N <br /> S B-4)UT M <br /> Special Reporting <br /> F] same as above EDF Required. Sample Disposal Clical <br /> 11Return fDisposal by lab E]QC E]EDF ❑ Raw DOM <br /> to <br /> Client: F—nv -4,urA A A El Yes �No <br /> 1. Relin(luished By Date Time 1. Received B3r'rV0_&,,,A'5 Date Time <br /> 'U%q I(Q J23 Uffl Ile 00 <br /> Addresq: Date T1 <br /> send copy to State of T—Relinquished Date 1"Ime 2 y <br /> City: aA�-em--Stateuk—ZiPV6 CA?(EDT) 81 j5A�P IME <br /> 1 <br /> C <br /> Date Time 3. Received By Date Time".O. r4A <br /> Attn: Yes ❑No 3. Relinquished By <br /> Eo—#—: X <br /> BC Laboratories, Inc.—41.00 Atlas Ct.—Bakersfield, CA 93308—661-327.4911—Fax:661.327.1918—www.bclabs.com <br />