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M ( r <br />Q <br />U) <br />M <br />0 <br />Laboratories, Inc. <br />Chain of Custody Form <br />Ref� 7b.Page <br />Client: C3I&I6Ql--lt- <br />�NA-tff! <br />Project #: 7-0)01 <br />of <br />Comments: <br />Attn: IrIV I <br />t"�'c <br />Project Name: <br />Address: <br />ILIVi 6]hrn-Ap CI <br />lilllal ID <br />City, State, Zi <br />CA gut <br />'sampler(s): <br />Phemuq <br />03L Fax. <br />Are there any tests with holding times less than <br />Sample Matrix <br />Email Address: <br />equal to 48 hours? <br />or No <br />;Work Order#:o <br />Standard <br />Turnaround = 10 work days <br />Other <br />Notes <br />—C <br />r -A 11 Jq'.1 <br />FF—F- <br />Same as above EDF Required? Glob ID <br />Weed for EDF) <br />System # <br />DT) <br />(Needed for EDT) <br />Client: <br />1. ell u d Date <br />0 Yes L1 No <br />Time 1. Received By <br />Dole <br />Time <br />1531 <br />Address:Time <br />2. Bell wished Dad I <br />Time 2. Received By <br />Date <br />City: <br />State - <br />Send Copy to State of <br />Zip CA? (EDT) <br />170c) P— �' P— k <br />I <br />I CLO'D <br />Attn: <br />3 quis ed By Date <br />ain 1.6 1(1 U <br />Yes No n <br />Time 3. Received By <br />&� <V <br />Date <br />Time <br />IPO#: <br />BC Laboratories, I I nc. - 4100 Atlas Ct. - Bakersfield, CAI 93308 - 661.327.4911- Fax: 661.327.1918 - vrA bclah, <br />M ( r <br />Q <br />U) <br />M <br />0 <br />