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BSK Log Number ANALYSIS REQUEST/CHAIN OF CUSTODY RECORD 1000- 05-23 <br /> Client Name sc< — � Prot5go69 Analysis required <br /> J 1 l� tab use Only <br /> Address Phone N in this <br /> 57Zq F Sic-,MCL Pf Ve— k15 wZ -10(50 section <br /> City, State, Zip Report, attention <br /> FIGURE 24 <br /> �IIlLsct✓u CA 7 wt 6 c 1Z <br /> Sampled by Sample f yaca <br /> Tempe -7-1Yy l Number Lab oy�a <br /> Date Time Seek of Sample Seals <br /> ampled sampled <br /> sp <br /> below Sample description ntainers number (See <br /> k eY Q? <br /> I below) Remarks <br /> 6/1 X <br /> ss/a� lyr.65 sb g-1 ,Uo . I e 13� I X <br /> b �r'89 (x : 17 5Q Q-r alb .Z e I 1 — X xPAMRI -f Y <br /> 'I II '' 1% S - Z ,,ho , l e !S' I X X <br /> t1 11 .59 so r- Z ,rjo , Z a, Zo <br /> 14 q ; ?,I SU B -3 ,Jo • I a;T Is f x X <br /> u g� B-3 1 A30-2 Cut Zo ' 1 X <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.P.A. SW 846 and that there is 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 550.00 per work order or$5.00 a bottle,whichever is <br /> greater. <br /> By: By: <br /> Authc#Azed Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by �,M ;Ole, 6ll5/8oi' 16 =oa <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Recenred by <br /> BSK KEY: Type:AO-Aqueous SL-Sludge SO-Soil PE-Petroleum OTT-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 /> Hazardous samples will be returned to client or disposed of at client expense. <br /> Telephone (209) 385-8310 - Fax (209) 385-7427 <br />