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ANALYTIML 1414 Stanislaus Stmet <br /> BSK Log 1\1II11117 <br /> MM <br /> Fresno,CA 93706 g(209)485-8310 Analyses Request / Chain of Custody <br /> (800)877-8310 AyuQ Date <br /> LABORATORIES (109)483-693SFAX <br /> Shaded areas for LAB uac naly Requested Ax! lyse <br /> f rro+Greaitieart�l Scrwle�e <br /> Vapry,► 8 k �� 0 5K Rep�irAsentlon. ��' �,� !o) �Z-� <br /> ✓1�` t'ml .Qaeoa ��Z_IQ� 3 aAx �� �r U <br /> Cuy, Z" r,! opy m sysum r 1 <br /> mncy; �`�i gwWany a <br /> wxhisir ire" Date Time Comment or <br /> p► Sampled Sampled Sample Descriptiond ocation Station Code <br /> X <br /> A' i/6 Y <br /> W 24 <br /> i v~A nit <br /> i 1 <br /> � 4 <br /> N <br /> Matrix L-Liq S-Solid G-Gas Additional Services Additional Services Authorized by Payment Received with Delivery <br /> Typo o aza s Associated with Samples Rush Priority [ ]-2 Day [ I-5 Day Date.- Amount. <br /> [ ]-Formal Chain of Custody [ ]-QC Data package Check 8 lnttish <br /> (Signature) Recrept9 - <br /> Signature Print Name Company Date Time <br /> RegixafW/Relipquished by' <br /> LAW= <br /> ura A 7 a: <br /> ReouvedlRalmpished by <br /> R.aiNW I ltdlingnebed br <br /> 012 ttewlew�= � <br />