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iW <br /> X 10(� ?45S <br /> SK Log Number ANALYSIS REOUESTICHF CUSTODY RECORD <br /> Prolec or PO# Analysis required <br /> Client Name <br /> • Lab Use Only <br /> Address in this <br /> l f O { O� � Qd o~� section <br /> Report attention <br /> City State,Zip <br /> y c <br /> Sampled by Cg? Number Lab Sample <br /> e <br /> Date Time of Sample a <br /> sampled sampled below) Sample scription ntainers number (See <br /> (/, r Remarks <br /> rose - ly <br /> 7- <br /> 20 d x x <br /> .�p 3 0 Y 1` X <br /> 3.V. 7 yofr 1 x <br /> r Y Y <br /> �� � !1 fl <br /> r i <br /> #12 0 t x <br /> r 0 ( 7 Sir" <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature in this section <br /> I am hereby requesting BSK s Normal Cham-of4;usiody 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 U 5 EPA SW 846 and that there is no mesa of <br /> procedureserally consistent <br /> that there is ath those outlined charge of$50001pertwo kPorderntract or$500ba Laboratory <br /> a Program <br /> hlicheve State <br /> extra charge for this service �r greater <br /> By <br /> By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Dae Time <br /> r <br /> Relinquished by G/f i ! — / <br /> L, iiiilo ` '�I ,"� <br /> Received by �✓ �� L/�1 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> KEY Type AQ-Aqueous SL-Sludge SQ-Soil PE-Petroleum OT-01her , <br /> BSSeals <br /> i J P-Present A-Absent B-Broken <br /> 1(` & Associates Chemical Laboratories DISTRIBUTION WHITE,CANARY LABORATORY PINK ORIGINATOR <br /> Note <br /> Samples are discarded 14 days after results are reported unless other arrangements are made <br /> 1414 Stanislaus Street Fresno, California 93706 Hazardous samples will be returned to client or disposed of at client expense <br /> Telephone(209) 485-8310 • Fax (209) 485-7427 <br />