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JS I T I V CHAIN OF CUSTODY AjP <br /> 781 East Washington Blvd, ANALYSIS REQUEST i <br /> Los Angeles,CA 90021 DATE PAGE OF <br /> LAB SERVICE (213)745-5312 FAX(213)745-6372 LOQ BOOK NO FILE NO LAB NO <br /> CLIENT NAME ANALYSES REQUESTED• • AIRBILL N0: <br /> COOLER TEMP: <br /> PROJECT NAME PROJECT NO PO NO <br /> PRESERVED: <br /> ADDRESS < QC REPORT <br /> / LEVEL'MANAGER PHONE NO FAX NO .L <br /> REMARKS: <br /> SAMPLER NAME <br /> (Pnmedl <br /> Same Da 1 =24 Hour, 2-48 Hour, jElc) N=NORMAL <br /> TAT(Analytical Turn Around Time) 0 R y, <br /> - <br /> CONTAINER TYPES B-Brass,G a Glass,P--Plastic,V -- VOA Vial,0-Other <br /> SAMPLE DATE TIME MATRIX CONTAINER ,/ SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATO SM UNt OD" "rA s ,wrc COMMENTS <br /> I'\V <br /> t>� <br /> P I <br /> El <br /> \L <br /> Fad <br /> J j -F- <br /> Relmquished By ISgnature and Panted Namel yReceived By{s9whae end PnMed Name{ Date T SAMPLE DISPOSITION <br /> 1 Samples returned to chenh YES NO <br /> Retmqu+ahed BY ISgnahxe snd PrrHed Neoral Recened By IS9ftWe end Ported Name) Ds* Tom <br /> 2 Samples vwll rroi be stared over 30 days,unless <br /> addtttonal storage gr <br /> is requested <br /> Relman <br /> qumhed By(SWatwe d PnMed Name) Received Of{Sgnawre end Pnrded Name) Dare rano + <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS 8y Date _____ _ <br />