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SMI-I'll-EwRY COMPANY <br /> The 1-W1 Sendr r luderrerideul T-1bw 1,nbowory,&1ablwW 104 CHAIN OF CUSTODY AND <br /> 781 Fasl Washington Boulevard • L-Angeles,California 90021 . ANALYSIS REQUEST <br /> 1'.U.Bua 880550,Flunter's Point Shipyard Bldg.114 • San Francisco California 941$8 • 415)330-300D 0 Fax:(213)745.3372 ) ! � s <br /> 5427 East La Palma Avenue t ( Fax:(4i5)822.5864 DATE: ' y PAGE OF <br /> • Anaheim,California 92807 • (714)693-1026 • Fax:(714)693.1034Z r r�1 i'1 1 n 1 <br /> FILE N0._ f LAB N0. r 7 7 <br /> CLIENT NAME: <br /> Der•.-c ANALYSES REOUESTED: <br /> REMARKS: <br /> PROJECT NAME: PROJECT N0. <br /> P.O.NO. <br /> ADDRESS: <br /> � t.v •'� � vr. c. .'Tc �V � US /ICrJ�' cf � /T <br /> PROJECT MANAGER: PHONE#.(>3as-) <br /> -o FAX <br /> SAMPLER NAME: <br /> ,- II �1rrnlBd(NJ ($18f181W9 r <br /> TAT(Analylicat Turn Around Time) 0-Same Day-, 1 =24 Hour, 2 a 48 Hour, (Etc.) <br /> CONTAINER TYPES: 8=Brass,G a Glass,P-Plask,V=Voa Vial,0-Other. o <br /> Lo <br /> SAMPLE DATE TIME "t °p <br /> NO. SAMPLED SAMPLED SAMPLE DESCRIPTION MATRIX CONfAMIER m SAMPLE CONDITION/ <br /> WATER SM a R TAT a ME COMMENTS: <br /> /vv-1 �ra ly� ���� <br /> ww 7/ 93 1.31s f . <br /> Fw % /?Y() X i <br /> %hR-T/ <br /> �� X <br /> 13 <br /> - s - <br /> RNingnishetl ey.I$wature and Panted l Received <br /> BY I -4 Prkrted Nemo <br /> DateSAMPLE DISPOSITION: <br /> : Tulle; <br /> r ( 4"�f yr ~" r T�� ( <br /> Ret'^W�Slled By(sgnaWra 1. Sam and Prim Namel eNH K. R 7 �r� n les returned to client? <br /> Recamw ST MOM" Printed rfarrre} Date. Timm. p YES <br /> 1/ r <br /> R2. Samples will not be stored over 30 days,unless <br /> ett aY�lsgnalure and Printed Name1 additional storage time is requested. <br /> Received Sy.(Si9nahue and Plklted Name) Date: 77ma <br /> SPECIAL.INSTRII,, rig; 3. Storage time requested: days <br /> ]BY <br /> _- _ DISTRIBUTION:WHITE,YELLOW, FINK TO SECO.—Gni n Tn r.1 tt=tiT <br />