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ANALY AL 1414 Stanislaus Street <br /> 3Fresno,CA 93706 BSK Log Number <br /> (209) -83106 (B00)877-8310 Analyses Request Chain of Custody <br /> r✓ <br /> Analytical Due Date f!^�r- <br /> LABORATORIES (109)485-6935 FAX r 1 V <br /> Ectal Surulcu. <br /> Shaded areas For Lag use only Requested Analyses <br /> Cheat Hama 2/� Report AAenaon '�J <br /> (lly/��/�/fi-'7vl C !y� Phoae x <br /> Address Project Quote Or PO# / f - -'v !. 3 FAX# - <br /> 11 <br /> FQvadd G�, <br /> CRy'Snte <br /> copy TO sn tem# <br /> �40 <br /> llf �f <br /> tLFR OAi}' Smpledby <br /> I <br /> Date Time G��le Comment or , <br /> hype Sampled Sampled Sample Descnption/Location Station Code v <br /> # COue <br /> ° etv- xX Ix <br /> I <br /> Ma="type L Liquid S-Solid G-Gas Additional Services Additional Services Authorized by Payment Received with Delivery <br /> Type of`� rds Associated with Samples Rush Pnonty [ 1-2 Day [ 1-5 pay // , Date- Amount <br /> 11-Formal Cham of CustodyData package Check# Initials <br /> ZrYe-/ aZ (Signature) Recrept# <br /> Signature Print Name Company Date Time <br /> Rep—W/Rdmqunhed by , , <br /> G �� !h e <br /> Reomved/Ralmgmahed by <br /> k m W Ralmgiushed by <br /> Recurved/Retmgunhed by <br /> i <br /> ReoetYed Or At , Z' 5 F <br />