Laserfiche WebLink
SMITH-EMERY COMPANY CHAIN OF CUSTODY AND y <br /> Thr Fall Service bulependmt T-mg Laboratory,wed 1904 ANALYSIS REQUEST <br /> 781 East Washington Boulevard • Los Angeles,California 90021 • (213)749-3411 • Fax:(213)745-6372 <br /> P.O.Box 880550,Hunter's Point Shipyard Bldg. 114 • San Francisco,California 94188 • (415)330-3000 • Fax:(415)822-5864 DATE: PAGE OF <br /> 5427 East La Palma Avenue • Anaheim,California 92807 • (714)693-1026 • Fax:(714)693-1034 FILE NO. LAB NO. ° <br /> CLIENT NAME 40te-^r, <br /> 1r /e H c-/f yr ANALYSEWREQUESTED: REMARKS: <br /> PROJECT NAME: PROJECT NO. P.O.NO. <br /> ADDRESS: 45-6 _ /Z 7-4 <br /> PROJECT MANAGER: P. 17,t:C4`r 11w 4, PHONE#: FAX#-. ---- <br /> SAMPLER NAME: ,L <br /> AT(Analytical Turn Around Time) 0-Same Day, 1 -24 Hour, 2-48 Hour, (Etc.) a <br /> CONTAINER TYPES: B=Brass,G=Glass,P-Plastic,V-Voa Vial,0-Odw. <br /> SAMPLE DATE I TIME MACONT °$ SAMPLE CQNDITIONI <br /> NO. SAMPLED SAMPLED SAMPLE DESCRWTION WATM Six OTM TAT a >ne <br /> COMMENTS: <br /> U--c— /,a t: y /Joo <br /> Ll <br /> /0 A Aj 1 /O 2- <br /> 5� l <br /> ialied .1 a and r"w , By rand Prfnlsd Name) Dai: Ttm� <br /> SAMPLE DISPOSITION: �;��� <br /> t nquisltad By:(Sgnaaae and Printed Name) 1. Samples returned to client? YES 'Z4-0 <br /> By:( and ftftd Nwm) Data: Tiffw <br /> Samples <br /> Relinquished By:(Spnakae and Prwill not be stored over 30 days,unless <br /> Gd Name) BY:(Sgnalure oral Prgged Nemo) �,: Ttrt� additional storage time is requested. <br /> 60 <br /> SPECIAL INSTRUCTIONS: Storage time requested: days <br /> By Date <br /> DISTRIBUTION:WHITE,YELLOW, PINK TO SECO—GOLD TO CLIENT <br />