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BBSK•og Num HJT ! NALYSiS RETIC OF ODMORMM 7 <br /> Client Name Project or PO fE <br /> Analysis required <br /> �r �oi, 2., Lab Use Only <br /> Addressn5-� <br /> in this <br /> -�_/ae:).2 section <br /> City,State, Report attention a `g <br /> Sampled by . Sample <br /> DateTime Number Lab <br /> sampled sampled <br /> G�"e of Sample Seals <br /> below) Sample description mritainers number (See key <br /> below) Remarks <br /> y3 3 c? V01 X10 oy'T` o <br /> a / <br /> r2-- x <br /> WTI <br /> !©of, V V <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature In this section <br /> I am hereby requesting BSK's Normal Chain-0f Custody Procedures for the above samples I understand that f am hereby requesting BSK s Formal Chain-of Custody Procedures for the above samples I understand that <br /> these procedures are generally consistent with those outlined in the US E PA SW 846 and that there is no these procedures are generally consistent with those outlined in US EPA Contract Laboratory Program Slate <br /> extra charge for this service merit of Work, Section F and that there is a charge of$5000 per work order or$500 a bottle whichever is <br /> greater <br /> By "��� By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by /-' C `� r 3 DO <br /> Received by - V CHS.�� r ' <br /> S1 ll� i1"r,� dZ C 7t1� <br /> Rehnqu�had by <br /> Recettrad by <br /> Relinquished by <br /> Received by <br /> -��� r{` KEY Type AO-Aqueous SL-Sludge SO-Soil PE-Petroleum OT-Other <br /> Seals P-Present A-Absent B-Broken <br /> & Associates Chemical Laboratories DISTRIBUTION WHITE CANARY LABORATORY PINK ORIGINATOR <br /> Note <br /> 1414 Stanislaus Street Fresno, California 93706 Samples are discarded 14 days after results are reported unless other arrangements are made <br /> Telephone(209) 485-8310 • Fax (209) 4857427 Hazardous samples will be returned to client or disposed of at client expense <br />