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:110 <br /> lllill <br /> BSK Log Numbe . - ANALYSIS REQUEST/C OF CUSTODY RECORD - <br /> 2 <br /> Client Name e- Prof t or PO Analysis required 93 <br /> Address / —? Lab Use Only <br /> Phone I in this <br /> (/4dr' G s�� l� ';;11 - MOO section <br /> City State r Report [tendon <br /> 1111011,1,946 (rel-Ap/;Pr <br /> Sampled by <br /> Date Time � �/ r G l�C Number Lab Sample y a� <br /> sampled sampled See key of Sample Seals <br /> below) Sample description containers number (See key <br /> below) \ I�c�� Remarks <br /> i <br /> d- <br /> b <br /> i <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature In this section <br /> am hereby requesting BSK s Normal Cham-0f-Custody Procedures for the above samples I understand that I am hereby requesting BSK s Formal Chain-of-Custody Procedures for the above samples f understand that <br /> these procedures are generally consistent with those outlined in the US E PA SW 846 and that there rs no these procedures are generally consistent with those outlined in U S EPA Contract Laboratory Program State <br /> extra charge for this service ment of Work Section F and that there Is a charge of$5000 per work order or$500 a bottle,whichever is <br /> r greater <br /> By By <br /> Authortzed Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished b <br /> .-� <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> BKEYSK <br /> Type AO-Aqueous SL-Sludge SO-Soil PE-Petroteum 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)485-7427 Hazardous samples will be returned to client or disposed of at client expense <br /> I <br />