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' r,_.... r,r • ^ Y r f R.!,- r , r,.i-. _ r-u r. rz,_ , *.i. r.. R,�., , , i. x-, rT,..,a. M-F-v.. r— 7 <br /> CHAIN OF CUSTODY AND <br /> f <br /> POSITIVE 781 East Washington Blvd., ANALYSIS REQUEST <br /> Los Angeles,CA 90021 DATE: PAGE OF <br /> �i IMI LAB SERVICE (213)745-5312 FAX(213)745-6372 LOQ BOOK NO- FILE NO. LAB NO. <br /> CLIENT NAME' ANALYSES REQUESTED: AiRBILL NO: <br /> COOLER TEMP: <br /> t' PROJECT NAME: PROJECT NO. P.O.N0. PRESERVED: <br /> b <br /> ADDRESS: OC REPORT <br /> PROJECT MANAGER: PHONE NO: FAX NO: LEVEL <br /> SAMPLER NAME: REMARKS: <br /> IPrintedl Isignalurel TM <br /> r <br /> t TAT(Analytical Turn Around Time) 0=Same Day; 1 =24 Hour; 2=48 Hour, (Etc.) N=NORMAL <br /> - <br /> i CONTAINER TYPES: B=Brass,G=Glass,P=Plastic, V = VOA Val,0=Other: <br /> SAMPLE DATE TIME MATRIX s,. CONTAINER SAMPLE CONDITION/ <br /> SAMPLE DESCRIPTION TATs <br /> NO. SAMPLED SAMPLED WATER son SLUDGE FRER ;; . n COMMENTS: <br /> P-9 <br /> I A Nk <br /> � _ <br /> �< F <br /> re <br /> Relinquished By(Signature and Priraed.NainelReceived By:ISignehae end Primed Nam) Date: time: SAMPLE DISPOSITION: ` <br /> 1. Samples returned to client? YES NO <br /> Rehrqurshed By-(S,gnature and Primm <br /> Primed Neel _ Received By:(Signalise and Prinmd Hamel Dale- Time: <br /> 2. Samples will not be stored over 30 days,uhless <br /> " petmquished By:{signature and Printed Name) Received By(Signature and Primed Name{ aeoa; - T,,1e: additional storage Ume.is requested. <br /> 3. Storage time requested: days <br /> SPECIAL INSTRUCTIONS: <br /> BY Date----- <br />