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OSITIVE HAiN OF CUSTODY A <br /> 781 East es,CA 90 Blvd, 101, , ANALYSIS REQUEST <br /> Los Angeles,CA 90021 ;I DATE _I �t9r7 PA F <br /> LAB SERVICE (213)745-5312 FAX(213)745-6372 LOG BOOK NO FILE NO LAB NO r <br /> CLIENT NAME a j J� ANALYSES REQUESTED AIRBILL NO: <br /> PROJECT NAME -c` r - PROJECT NO I t ; , P O M COOEER TE - <br /> PRESERIIED' <br /> ADDRESS ? , . ' QC REPORT <br /> PROJECT MANAGER �t '"I '�` r T �k PH(WE fi -' , r- FAX NO C}y -� �'� ; f I LEVEL' <br /> SAMPLER NAME f , r Wr vti/� �- REMARI(S. , <br /> tPr nted) (Signature) � - <br /> AL <br /> TAT(An tical Turn Around Time) 0=Same Day, 1 -24 Hour, 2=48 Hour, (Etc) N=NORMAL 40 <br /> "�. <br /> CONTAINER TYPES Br s,G-Glass,P= Plastic, ;__u�Vial,O=Other <br /> SAMPLE DATE TIME MATRIX CONTAINER q� SAMPLE CON©ITIONI <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATER sori SLUDGE OTHERTAT 'Pte COMMENTS, <br /> or <br /> Awl 7, ill>l.,r� / j n�� :toh 10' <br /> c ,-� ,, r ✓ ; <br /> >1 <br /> v <br /> ff <br /> L <br /> I <br /> Rel ed 9tT(Signature and Pnnle NaI RiC ey{S _ri i ,�p fa,1 ,�}erne AMPLE DISPOSITION �� <br /> �,} 7 ' i t AA vt+l ---�--=j f V'v (JIf =L + 1 tr 1 Samples returned to cBent� YES (' NO J <br /> Relinquished N{Signature and Printed Namel Received By(Signature and P t ami) Date Time <br /> 2 Samples will not be stored over 30 days unless <br /> ` additional storage time Is requested <br /> Relinquished By(Signature and Printed Name) Received By(Signature and Printed Namer Date Time +� <br /> 3 Storage time requested <br /> SPECIAL INSTRUCTIONS <br /> 8y ` <br /> F`1 ICr�IT P`f1pV j <br />