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BSK'umbo ANALYSIS QUE HAICUSTODY RI D1W 4F V <br /> 1_ <br /> Client Name Protect o PO p An required <br /> "el- ff <br /> Lab Use Only <br /> Address Phone N in this <br /> 0 - section-6-74-2 �Ifl <br /> Cu/ State,ZipReport at ntion <br /> j�a�iSazy�°y P r6L lwotlet <br /> Sampled NumberSample <br /> r mLab Speals g� <br /> Date e Time 4 / to <br /> sampled sampledeeetow) Sample descnptron tamers number (bOO key Z'°�y� Remarks <br /> OL5 149 IC2 <br /> X73 3 o fr 1 3 x <br /> 33 ? 5-s ,4 7- 1 7 x ac <br /> it 3 / 8 Gomer- 1 ~� x X <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <br /> I am hereby requesting BSK s Normal Cham-0f-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 US. E 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 servtm ment of Work,Section R and that there is a charge of$50A0 per work order or S5A0 a bottle whichever is <br /> greater <br /> By By <br /> Authorized Signature Authonzed Signature <br /> Signature Print�Name Company 7 Date Time <br /> Relinquished by <br /> Received by r X3 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received try <br /> j KEY Type AO-Aqueous SL-Sludge SO--Sail PE-Petroleum CIT-other <br /> Seals P-Present A-Absent B-Broken <br /> BSK & Associates Chemical Laboratories DISTRIBUTION WHITE CANARY-LABORATORY PINK-ORIGINATOR <br /> Note <br /> 1414 Stanislaus Street Fresno, California 93706 Samples are discarded 14 days atter results are reported unless other arrangements are mad& <br /> Hazardous samples will be returned to client or disposed of at dent expense. <br /> Telephone(209) 485.8310 • Fax (209) 485-7427 <br />