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BATT Numbed—Aff 'MALYMEQIffl%T/CH C DY RMRD <br /> Client Name Prole t or PO# <br /> er 11r Al2Lab Use Only <br /> l pr� Analysis required <br /> Address Phone N in this <br /> section �1 <br /> City State Zig/ Report attention fj <br /> //e A.T1'`�►'�Samp t� �G��-1 `�� �C I F cP' --/— <br /> l�e led by Number Lab Sample <br /> Dale Time He Seals <br /> sampled sampled al number <br /> v <br /> below) Sample description nlalners number (S"key <br /> below) ` Z g Remarks <br />•y 3 <br /> f1rivo.,5- 50 9 /o/ -0 0 ;70 7 t D v 1 X <br /> 0 -11�// 4/ tI r X- <br /> 15-5- Y O 07r- 7' 1 K X <br /> /64G o 7— <br /> a ? D 8�. ? #3 3 0 7C r <br /> o Y8 Ifr <br /> 038 - 7 <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 t am hereby requesting BSK's Formal Chaln-0f 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 service meat of Work,Section F,and that there is a charge of$50A0 per work order or$500 a bottle whichever is <br /> greater <br /> By By- <br /> Authorized <br /> yAuthorized Signature Authorized Signature <br /> Signature Print Name / Company Date q / Time <br /> Relinquished by R (t G t cf fI�! —p <br /> / s (� ` <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> BS� l KEY type AQ-Aqueous SL-Sludge SO-Soil PE-Petroleum OT-01her <br /> 1 Seals P-Present A-Absent Broken <br /> & Associates Chemical Laboratories DISTRIBUTION WHITE,CANARY LABORA70RY PINK-ORIGINATOR <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 will be returned to client or disposed of at client expense <br /> Telephone(209) 485-8310 9Fax (209) 485-7427 <br />