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BSK Log Number ANALYSIS REQUEST/CHAIN OF CUSTODY RECORD 1000- 7451 <br /> Client Namep Project W P.O.N f (/f 3 Analysis required <br /> [1 / �C4ta >`oH L Orli'OUevhea� Lab Use Only <br /> Address // ��OO Phone M in this <br /> QUu'r L S(U Y6 - Yd00 section <br /> City,Sta ip Report,attention <br /> C4saa1`aH Fva G�'c vvo `� ��� <br /> Sampled� <br /> Number Lab Sample � <br /> Date Time /( l. of Sample Seals \ � <br /> sampled sampledo key <br /> bokxv) Sample description tains number bellm) y Remarks <br /> 9 8I OT -S -3 <br /> 9� M*0 OT tires-d <br /> oT <br /> ! 9,2 <br /> 4,/"00 40 S%& !U lei' <br /> CHROMALAB FILE N 692120 <br /> ORDER # 67Z$ <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$50.00 per work order or$5.00 a bottle,whichever is <br /> r greater. <br /> By By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by 0�` <br /> Received by �— 7 1!/L (i�R7 rs1 q [ e - b/ /1 9'L / 2 z 2.._ <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> BSK KEY: Type:AO-Aqueous SL-Sludge SO-Soil PE-Petroleum Or-Other eee�.r«>Jf <br /> Seals: P-Present A-Absent B-Broken <br /> & Associates Chemical Laboratories DISTRIBUTION:WHITE,CANARY.LABORATORY PINK-ORIGINATOR <br /> Nae: <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)485-8310 Faz (209)485-7427 <br />