Laserfiche WebLink
BCA Log Number <br /> CHAIN OF CUSTODY RECORD <br /> Peni name1 Project or POk Analyses required <br /> � L_ 2 <br /> Address Phone p 7 ti/Q <br /> j� <br /> City State Zr _4 '- tRertatte <br /> r Sampled by <br /> Lab a Number a <br /> Sample Hate Time See key � of <br /> number sampled sampled below Sample description containers �4. 1 y Remarks <br /> AS!,- S'n ' { X <br /> A(, . -s-5 - + x <br /> -5-Ar-k"qts.- 7o I <br /> AS_i --7 �( <br /> nZ X <br /> Signature Print Name Company Date Time <br /> Relinquished b ✓ �� 3 <br /> Received <br /> Relinquished by <br /> Received by y <br /> Relinquished by, U <br /> Received by Laborato <br /> B C ANALYTICAL Note Samples are discarded 30 days atter results are reported unless other arrangements are made 'KEY AG—Aqueous NA—Nonaqueous SL—Sludge <br /> ❑1085 Shary Circle Concord CA 94518(510)625-3894 Hazardous samples will be returned to client or disposed of at client s expense GW—Groundwater SO—Sod PE—Petroleum <br /> 0 801 Western Avenu lendale CA 91201(818)247 5737 Disposal arrangements <br /> ❑iMne A a1MA 928M)978M <br />