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M <br /> ANALYTICAL 1414 Stanislaus Stmet,Fresno,CA 93706-1623 E01W1ME /31/0709 <br /> B S K LABORATORIES (559)497-2888•FAX(559)497-2893 •W W W.bsklabs.com Geo con <br /> TAT: <br /> 331018 Standard <br /> •Required Fields TEMP: <br /> Client/Company Name r: Report Attention r: Phone•9: C[ FAX•M >- <br /> C, J NSULtAf.v f5 Kull-1vj til E-mail: ANALYSIS REQUESTED <br /> Address r , I City• State• zip <br /> Carbon Copies: <br /> Q �"✓r — AC CDHS❑ Freama Co❑ EPA❑ �qI <br /> Project Information: PO N Merced Cc ❑ Tulare Co ❑ i <br /> C -c <br /> -ziut/�i-p�� .(,tl�. Quote, Other. <br /> How would you Eke your completed results sent? ElE-Mail11 Fax F]EDD I ?Rail Only Regulatory Compliance <br /> X� Electronic Data Transfer. Y❑ N❑ <br /> Sampler Name Printed/Signature QC Request Result RequesNrSurcharge System No.• <br /> J � �p/� r l7"—' []STD []Level 11 TD❑SDayrr❑2 DayrrD Dayrr <br /> Matrix Types: SSW=Raw Surface Water CFW=Clorinated Finished Water CWW=Churinated Waste Water BW=Bottled Water 3 <br /> RGW=Raw Gmund Water FW=Finished Water WW=Waste Water SW=Storm Water DW=Drinking Water SO=Solid p <br /> Sample N Sem led Sample Description/Location• Matrix Comments I Star Code <br /> # Bottles Dete Time - - - <br /> 513010 f<]o w 112o X <br /> loin <br /> 1 �W-5 2yb <br /> ------------- <br /> iZvo la/sw-3 2x <br /> Relinquished by.(Signature and Printed NMe) Company Date Time Received by(Signature and Print Name) Company <br /> Jul+fie �e ,? Foca 3I3t1r7 be 1 C S <br /> Relinquished by:(Signature and Printed Name) Company Date Time Received b (Signature gnature and Print Name) Company <br /> Received for Lab by:(Sign ' ted Name) Date TQwa `�- Payment Received at Delivery: <br /> Date: Amount ChecktCash/Card PIA M <br /> Erie <br /> Shipping Method: Cooling.Method: Packing Material: <br /> CAO UPS ALK-IN SNC FED EX OTHER WET LUE NONE <br /> Nees days eamwhrn mwlkarLIfrormpaidermwibaLvxaandry dtrl'mqueu.DdmgientbelanmartmbjatmmmAilYsmd<e5ebillmg rlmgaan,inn,_pkaAacd u I la%rclard,18%per.BSK&A tusl hcrnmlMm <br /> a®cambe���e�mexonfrollectiooq arduriagamaeyifs irrnmdpdorm mmliegaeon whW,crcmdadn{bYP�d6a�'aa.smlvncnScuipmmic araaimvivn Thc pvmns ring drcdioW'CooPenY W��leYar1mmvlel4rathatttvyam6ticlhcQimtoramho� ache Q' ud the Client <br /> royomibkfmpaymmrforamlYemismim on d¢sChain ofCusrody.An madfimdonoftemWysisequcs46�Wmqu fim rialeroW andv®¢dupon this LlvinafQmady.TlrcmnmowCmrckrany surmla maeitNefle3W pn will bcgnthcnatbu.��daY. m.racaiamu,.nemn <br />