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'7 .r <br /> BSK Lag Number—aim ANALYSIS REQUEST/CHAI CUSTODY RECORDr M � 71 <br /> Client Name Prole tt or PO if! <br /> Address Vae ee �� �oo�S �<��l�� only <br /> Analysis required <br /> Phone N Lab Use on <br /> in this <br /> section <br /> City Slate Zryy,, Report,attention � �tc�� � �� <br /> sampled by / <br /> Date Time Type He Number Lab Sample i ,[ <br /> sampled sampled Seek of Sample Seal <br /> below) Sample description ntarners number I�key a ' <br /> below Z g" Remarks <br /> 50 �o /o �o ,�7- p X X <br /> Y r o tel/ r 1 / X <br /> ss v AO 7 1 x � <br /> lGoG <br /> D <br /> o 70 f0 x x <br /> /0/y � So �T -7 +XX K <br /> o3g <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <br /> I am hereby requesting BSK s Normal Chamof-Custody Procedures for the above samples I understand that I am hereby requesting BSK s Formal Chain-0f Custody Procedures for the above samples.1 understand that <br /> these procedures are generally consistent with those outlined in the US EPA SW 848 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 service 1% men[of Work,Section F,and that there is a charge of$5000 per work order or$500 a bottle whichever is <br /> By greater BY <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by /�'rO p <br /> Received by (�J! . _7 <br /> 7 ` <br /> /r <br /> Relinquished by <br /> Received by <br /> Relinquished by =t <br /> Received by € <br /> KEY T <br /> BSK <br /> ype A(]-Aqueous SL-Sludge GO-Soil PE-Petroleum OT-0ther <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 <br /> Hazardous samples will be returned to client or disposed of at client expense <br /> � <br /> � I <br />