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BSK Log Number ` ANALYSISEOU /CHIUF C"DY �RD_ <br /> h Client Name �5 O Prolecj.or PON Analysts required <br /> r tJ ( Lab Use Only <br /> Address P ne!i in this <br /> DSD Od11 -l U - (J(Jd section <br /> City State ZIP Report,attention m <br /> S Ck oil / mv(b- c qlm) -- r-5 C} <br /> Sample " 3- <br /> Sampled by ', B Number Lab Seals �� m / <br /> �•Gl <br /> Dale Time See ke of Sample �, (� /•'i< r� �It S <br /> sampled sampled below) Sample description terriers number (eek r re Remarks <br /> I <br /> /og. S fr ' � ) Y C cN <br /> P td�Sf 1 <br /> heu ey cu X' q6 <br /> )at <br /> l �03 M 0 3 r ► �C ( �,1 Y 3 T <br /> u S� <br /> Q (,4 rel 07 V'q6 I-r- <br /> ---- — --- -- <br /> 7C 10 <br /> +r SO IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <br /> Formal Cham of Custody Procedures for the above samples I understand that <br /> I am hereby requesting BSK s Normal Chain-of Custody Procedures for the above samples I understand that I am hereby requesting BSK s <br /> b <br /> these procedures are generally consislonl with those outlined in the US EPA 5W B48 and that there IS no tmnt oft Work urSection Fna di that there is artchafrge of$5000iperlwork Porder or$500A Contract ba bottle oratory Pwhgch verram t is <br /> extra charge for this service. � greater � <br /> _ By <br /> By-���� AuthorizedSignature Authorized Signature <br /> Print Name Company Dale Time <br /> Signature <br /> Relinquished by ` `J f✓ iy e /' Sk ��t''�fQ �' �"''yT <br /> Resew tarti<rs [�"6E��/r�5 A5,� �< in eq r ��S r ¢7 <br /> IV <br /> Rehngw � � <Za S <br /> Receive <br /> Relinquished <br /> Receryed by�`- � y <br /> KEY Type AQ-Aqueous SL-S udge Srod PP-Petroleum OT Other <br /> Seals P-Present A-Absent B-Broken <br /> 55 Chemical Laboratories DISTRIBUTIONS FPTE,CANARY LABORATORY PINK-ORIGINATOR A" <br /> - ` <br /> Note �`- J__ ff <br /> < Samples er�s°�r 14 days altar results are reported unless other arrangements arQrrraga� /c, 1(�- �� <br /> 1414 s tr es o, CaLfornia 93706 �,A,�/ s Hazardous's '—s wdl be returned to chant or disposed of at client expense <br /> "- r relet one f2 48 10 • (ax (20 4857427 /� n /� I `2'A <br /> /t - /l .�-� 1 i r �nl '�-ti f- !a i `/�l� '0�i�� <br />