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ANALYST' l'CHA� cCl�arvt7YFic�.vlt3d 1 <br /> ��4�' ' 1 <br /> BSK Lop Number } L-' <br /> Praecl o t?O.N Analysis rogtstired - <br /> Client tfame 6t Gi?G lll�S t/G �� v 2� '107 Lob Use 0* <br /> Phone f In this J <br /> section z �, <br /> City.Slate.Zip naport,attanti <br /> �NtY <br /> s ockto r, sample <br /> Sampled by * L/l' e s <br /> Number Lab Seals Q=� 9 � ✓/`�� ,eCad.:v <br /> Date Time a number <br /> / m ' <br /> Sae dsalptiat Seiner_ number I4�ek) Z y Remarks <br /> Sampled sampled below) <br /> -- � Q•S�� <br /> IMPORTANT NOTICE:No camp;eS will be analyzed without an aulhorized signature in this section. of he <br /> samples I <br /> rstand trial <br /> CUStQdlf <br /> ures I <br /> I am hereby requesting BSK-s Normal Chainof Cuslody Pro�d+yes S E.eA 5W!848 and understand <br /> thsranlsknot these procaduresesting BSK's Formal e a ganeratly consistent with those outlined Idn U5.EPA Contract LatwralayrPreogram Slate- t <br /> I procedures we generally consislern with kkW9e outlined kt lira ment of Work,Sadlon F and that there is a charge cl SS000 pet nrork order or 5500 a botlte.wNct,000 is <br /> extra charge for this service. �t greater. <br /> 8y:� �� By., Autharixed Signature t <br /> T- putlwrlusd Slgnatrxe <br /> Company Date �7Tkme <br /> Glgnature Print`lame �J� , �4'•rs <br /> Relinquished by <br /> Rea <br /> by ,� �,�� i��fs fK f *l/Y�`¢ •Q ; <br /> Regn " <br /> n p i <br /> R N � �/ /f� +�5 l G i✓� $i.52, <br /> Ott/ <br /> RasrrWW*dby u.IQ-,, 1'�iv� C.�rit�✓ �S �L��Shrf7�N 1 �/ <br /> Received by <br /> -- ✓1 //,, fi�r- :/ <br /> /ran L•� KEY' Type:Ap-Ar�i ..' L-Slucrga SO Solt PE-Petrdeum 07-Other ! <br /> i Seats,P-Present 8-Broken <br /> tel t� a 10talOTleS `� ���rl OISTRIBI1Tt- CANAF^( <br /> j � � •LABORATORY PINK•OR1GlNATOR <br /> r Nde: <br /> Samples aro discldtltl Ay-aflar results are reported unless other enangemonls ar�1n 1 <br /> 51 r .nia 93706 Hazardous samples win be returned to diem or disposed°l ori anent expense. <br /> /� phone 485 0 10 • 1 7.427 _ <br /> _ s <br /> } <br />