Transcription of LABORATORIES Chain of Custody - BC Labs
1 BC LABORATORIES . 4100 Atlas Court Bakersfield, Ca. 93308. (661) 327-4911 s FAX (661) 327-1918 s * Required Fields TEMP: Chain of Custody Client/Company Name *: Report Attention *: Phone * #: FAX * #: E-mail: ANALYSIS REQUESTED. Address * City * State * Zip * Carbon Copies: CDHS Fresno Co EPA. Project Information: PO # Merced Co Tulare Co BCL Quote # Other: How would you like your completed results sent? E-Mail Fax EDD Mail Only Regulatory Compliance Electronic Data Transfer: Y N. Sampler Name Printed / Signature QC Request Result Request ** Surcharge System No. *. STD Level II STD 5 Day** 2 Day** 1 Day**. Matrix Types: RSW = Raw Surface Water CFW = Clorinated Finished Water CWW = Chorinated Waste Water BW = Bottled Water RGW = Raw Ground Water FW = Finished Water WW = Waste Water SW = Storm Water DW = Drinking Water SO = Solid Sample # Sampled Sample Description / Location * Matrix * Comments / Station Code # Bottles Date Time Relinquished by: (Signature and Printed Name) Company Date Time Received by (Signature and Print Name) Company Relinquished by: (Signature and Printed Name) Company Date Time Received by (Signature and Print Name) Company Received for Lab by: (Signature and Printed Name) Date Time Payment Received at Delivery: Date: Amount: Check/Cash/Card PIA # Init.
2 Shipping Method: Cooling Method: Packing Material: CAO UPS GSO WALK-IN SJVC FED EX OTHER. WET BLUE NONE. SR-FL-0012-00 (Analytical).
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