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-x Log- AMIS ST STO COW IF <br /> 4 <br /> Client Name ProjW or PO# &? <br /> Analysis required 7 <br /> ��q <br /> iv C I Lab Use Only <br /> Address Phone // in this <br /> 3�d l0 W� — �dt� section y 5t f� ��Ob <br /> City Slate Zi Report attention Z O �m �� <br /> Sampled by ' Number Lab Sample <br /> Date Time i2-e -Y"/ r /l?C of Sample Seals {ym <br /> sampled sampled Seekcontainers number (See key {� Remarks <br /> below) <br /> below) Sample descdescription �` <br /> a � <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature In this section <br /> I am hereby requesting 8SK s Normal Chain-of-Custody Procedures for the above samples I understand that I am hereby requesting BSK s Formal Cham-of-Custody Procedures for the above samples I understand that <br /> these procedures are generally consistent with those outlined in the US 5 PA SW 846 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 ment of Work Section F and[hat there rs a charge of$5000 per work order or 5500 a bottle whichever is <br /> r greater � <br /> By---T � — By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date /*Time <br /> Relinquished b r G /� GJ /� /J / �3 �'C�• s <br /> Received by r `'�c, �'" 7-7. 3'.2,5 <br /> 1 <br /> Relinquished by <br /> Recerved by <br /> Relinquished by <br /> Received by <br /> SK <br /> KEY Type AQ-Aqueous SL-Sludga SO-Soil PE-Petroleum OT-Other <br /> rL^7J Seals P-Present A-Absent B�-Broken <br /> & Associates Chemical Laboratories DISTRIBUTION WHITE,CANARY LABORATORY PINK-ORIGINAMR <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 witl be returned to client or disposed of at client expense <br /> Telephone(209) 485-8310 9 Fax (209)485-7427 <br />