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=�C�0 <br /> M = = M � ' 'Tf#76 �r <br /> ANALYSIS REQ ST/CH F CUSTODY RECORD <br /> BSK Log Number ��U ) <br /> Client Name Pro t or PO N ` Analysis required <br /> J L r Lab Use Only A, <br /> Address Pone N in this _ V <br /> section <br /> City,State,Zip <br /> Report,at noon <br /> —`7 <br /> Sampled by Sample �� <br /> REG Number Lab Seals <br /> m <br /> Date Time of Sample <br /> sampled sampledBe ' Sample description number (�key r� Remarks <br /> be C below) <br /> 7` 0 <br /> S� u K igss, �er s7`cl<<� <br /> tt <br /> 10113 <br /> D 6 S 3 O f U( K fe<?t uie. (re +mak.-rte <br /> •Hctat <br /> x .cC C�rs7 w <br /> jj \V 2 x <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <br /> I am hereby requesting BSK's Normal Chain-0hCusiody Procedures for the above samples I understand that [these <br /> m 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 nosprosof kurSectioes arenFriandltfiat therms altcharge of$50i70ose outlined iper4workPorde�nora$5b0 ct a boottery Pwh9cheverram taseextra charge for this serviceater <br /> By By <br /> Authorized Signature Authorized Signature <br /> Signature <br /> Print Name Company Date Time <br /> / <br /> Relinquished by �I /� �i��� f� 60 <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> KEY Type AO-Aqueous SL-Sludge SO-Sod PE-Petroleum OT-Other <br /> BSealsSK & <br /> P-Present A-Absenl B-Broken <br /> Associates Chernlcal Laboratories DISTRIBUTION WHITE CANARY LABORATORY PINK ORIGINATOR <br /> Note <br /> 1414 Stanl5laus 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 /> e(2091 485-8310 • Fax (209) 485 7427 <br />