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BSK Log Number ' 7. ANALYSIS REQUESTICHATIF CUSTODY RECORD 10* 7459 <br /> Client Name Project or PO# Analysis required <br /> a l�j <br /> &n �/� Lab Use Only <br /> Address //'' Phone# in this <br /> 70 (�v�t /' 00 1 section <br /> City State,zip Report attention <br /> Sampled by , Number Lab Sample X17 lis— <br /> Date Time / / r f/a o! Sample Seals n l <br /> sampled sampled blow Sample description ntainers number {See key `below) r°�Q� Remarks <br /> q s�s �r 3 XIX L <br /> IMPORTANT NOTICE No samples will be analyzed without an authorized signature In this section <br /> am hereby requesting BSK's Normal Chain-0f-Custody Procedures for the above samples t understand that I am hereby requesting BSK's Formal Chain-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 Stale- <br /> extra charge for this service ment of Work Section F,and that there is a charge of$5000 per work order or$500 a bottle whichever is <br /> � greater <br /> By By <br /> Authorized Signature Authorized Signature <br /> Signature Print Name Company Date Time <br /> Relinquished by )7 p7 <br /> , <br /> Received by �� [� (?t3 <br /> 3 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> KEY Type AO-Aqueous SL-Sludge SO-Soil PE-Petroleum OT-Other <br /> Seals P-Present A-Absent B,-Broken <br /> & ASSOCIate5 Chemical �aboratortes DISTRIBUTION WHITE,CANARY LABORATORY PINK ORIGINATOR <br /> Note <br /> s 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 /> • Fax {209)485-7427 <br /> 310 <br />