Laserfiche WebLink
67BSK Log Number ANALYSIS REQUEST/CH F CUSTODY RECORDlu 7 CTCT7!� <br /> Ghent Name Project o PON Anal s required <br /> C� 6 o f ,,2 <� <br /> Address Ph _ Lab Use Only <br /> Phone N in this <br /> V ± r SlQ V� section ), ib <br /> City Stat /Zip Report,a neon <br /> Sampled by / �`S' �J <br /> Date Time Type Number Lab Sample <br /> sampled sampled Seek of Sample Sea <br /> Wow) Sample description Donlainers number (See key <br /> below) d�o� Remarks <br /> q o t3 j o <br /> 0 1A. <br /> a ly #3 3 0,/-- <br /> _L0 <br /> f0 <br /> 3 <br /> 33 `# 7 ✓�' � 7 ?C K aC <br /> 13 / 3 <br /> 13Y � #� � sfr- <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <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 Formal Chain-of-Custody Procedures for the above samples I understand that <br /> these procedures are generally consistent with those outlined in the U S E PA SW 846 and that there is no these procedures are generally consistent with those outlined in US, EPA Contract Laboratory Program State <br /> extra charge for this seance ment of Work Section F and that there is a charge of$5000 per work order or$500 a bottle whichever is <br /> 8y greater <br /> /!L By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by00 <br /> �� � ✓ !� /� �� � fJ <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> BSK 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 Stani5laus 5treet 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 />