Laserfiche WebLink
A N A L Y T L 1414 Stanislaus Street <br /> ,} Fresno,CA 93706 BSK Log Number <br /> (209)485-63k0 Analyses Request / Chain of Custody ' <br /> (B00)877-8310 LAnstlytical Due Date <br /> LABORATORIES (109)485-6933 FAX J 17 <br /> E G Sa.atccs Shaded areas for LAB use only Requested Ana Ses <br /> CbeutName RepoatAneatwnPboae p <br /> � <br /> Add= praises Quae Of PO q � �! ' � FAX 0 <br /> OttY,Stets,Zip copyto System K <br /> 1 <br /> 1154 only led by <br /> Date Time 'f i C r�!!!G' Comment or <br /> Typo 0 Sampled Sampled Sample Descrtptcon/Locatwn Station Code <br /> * Cous. G <br /> 46 x <br /> A <br /> { i <br /> Matnx Type L-Liquid S-Solid G-Gas Additional Services Additional Services Authorized by Payment Received with Delivery <br /> Type of Hazards Associated with Samples Rush Priority [ ]-2 Day [ ]-5 Day Date, Amount S <br /> ] }-Formal Chain of Custody [ ]-QC Data package Check# Initials ^ <br /> (Signature) RecleptiY <br /> Signature Print Name Company Date Time <br /> t <br /> Requested/Relmqusshed by � Oe) <br /> Received/RelmquuW bye <br /> Received I Relmquuhed bjr <br /> Received/Relmquesbed br i <br /> Reonvod€or LabotatosY Y i J � �l r <br />