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Aft Ank <br /> SPL, In.C. SPL Workorder No HM9D0 7 O p 5 <br /> Analysis Request &- Chain of Custody Records ��� page of <br /> Client Name PA{Z,Scs SSS matrix bottle size pres ` Requested Analysts <br /> AddresslPhone J OJ 1"!Aft IN/1 V I LLAL -'iMteR4 O <br /> 1 i-. <br /> Client Contact A t-A "} ,_ N <br /> II I z <br /> ° cis <br /> Name o 0�/ >tl o c <br /> OQ "' 0 <br /> ProtectNumber g 1 '0 <br /> t <br /> U 1 <br /> Protect LocationS-/"4(le -0 tko 1." � y 0 &. <br /> — N U V <br /> Invoice To U S Lj rt A e u>e of L7 �I,�.{t,S o q S' G� .-7 L 3 11 R, 00 N o x x 0 <br /> SAMPLE ID DATE T1ME comp grab II oo !i m z i\ <br /> 3 C U <br /> vi0-3 <br /> Client/Consultant Remarks laboratory remarks PH= J Intact? &Y ❑N <br /> TPN _Cb�� PH ITernp 6C-1 <br /> Requested TAT Special Reporting Requirements Fax Results ❑ Raw Data ❑ Special Detection Urruts(specify) PM review(rnA4A <br /> Standard QC ❑ Level 3 QC [j Level 4 QC ❑ <br /> 24hr ❑ 72hr ❑ I Rebnquislt Sampler date trnie 2 Received by <br /> 48hr ❑ Standard 3 Relmq rs ed by datt time 4 Received by <br /> Other ❑ 5 Relinquished by date tune 6 Re b Labo tory <br /> 3)io )94;1 <br /> I <br /> /W 8880 Interchange Drive, Houston,TX 77054 (713) 660-0901 500 Ambassador Caffery Parkway, Scott, LA 70583 (318) 237-4775 <br /> ❑ 459 Hughes Drive,Traverse City, MI 49684 (616) 947-5777 ❑ 1511 E Orangethorpe Avenue, Fullerton, CA 92631 (714) 447-6868 <br />