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i L1:::15F COA9Yid"E F: <br /> Laboratories,Inc. Chain Of Custody Form <br /> 130 Mori EIS <br /> Client:-H( Ml fc"0-46, i1 L. Project# <br /> Comments: <br /> Attu, �4,$ r Pro ect Name: C` L <br /> !� D-1 110 <br /> Street Address: 5:i (Vrrt6 Project Code: 4 .1€z° £ r "=€` i s ,>< t = s <br /> ® sa .t t �t <br /> Ci State Zi r Sam ler(s): v+ Uhf � s� 3 '� rin h.S � 1 �' <br /> =n r t s,+ii IS .,.ia.} �Ci <br /> Phone:�° Y�7�tr Fag: ~'' Are there any tesls.iiih hutdiug Mmes less"'an <br /> l Samtle Matrix or equal to 48 h ars" <br /> ljf! Sa (* v <br /> Email Address; �,t(t,, <br /> � - '' 3 ; „ g� ❑ vas t3a <br /> Submittal# 3 d <br /> „G� s <br /> � 7� *Standard Turnaround_75 work day <br /> tfQ Notes <br /> Sampled# Sampled �, A 5 3 Other <br /> Z a`! f�)t j x <br /> 144AMA <br /> lszs <br /> VV e- <br /> we 1) JSJ13 <br /> IV ; ly <br /> r <br /> F-1 <br /> Same as above Report Drinking <br /> Sample Disposal Special Reporting <br /> Waters on state Form? ❑ Return to Client yDisposal by lab ❑ Archive: Months_—__ ❑ QC ❑WIP ❑Raw Data <br /> Client: Lai .ti/G."�� _ 1- - I. Relinquished By Date Time 1. Received By Dat Time <br /> ❑Yes [ No Z / 5 9 e _�-. � C1 <br /> Address:_qq q q A u,11,:4 _ —--——— <br /> rp 3 Send Copy to State of Relinquished p Date Time 2. Received By r\ ) Dole i e <br /> City: ��•tjjAl �Gi _�State Zip Ca? + 1 <br /> Attn: C�h t l$`��n th, L- j ' tJl Yes No <br /> � 3. Relinquished By Date Time 3. Received By Date Time] ❑ <br /> PO#: <br /> Y0 BC Laboratories,Inc.-4100 Atlas Ct.-Bakersfield,CA 93308--661.327.4911-Fax:661.32 7.1918-www.bclabs.com <br />