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�sMt l'11=t:M�iiy 04tIAAkY CHAIN OF CUSTODY AND <br /> The 1•id1.S'en ice lndry+encirw Testing Laboratory,Established 1904 AN LYSIS REQUEST <br /> 4D) 781 Fast Washinginn boulevard • Los Angeles,California 90021 a (213)749.3411 • Fax:(213)745.6372 __..,L ! f i <br /> P.t).Mix 880550,Hunter's Point Shipyard bldg. 114 • San Francisco,California 94188 • (415)330.3000 • Fax:(415)822-5864 DATE: PAGE_._. I OF I <br /> 5427 last La Palma Avenuc • Anaheim,California 92807 a (714)693-1026 • Fax:(714)693-1034 FILE NO. 7 LAB NO. l__l r1 <br /> CLIENT NAME: QIr-(u,, /L ' ANALYSES REQUESTED: REMARKS: <br /> PROJECT NAME: PROJECT NO. P.O.NO. <br /> ADDRESS: <br /> 7o �r Tc /v ZA /IV <br /> C ff <br /> PROJECT MANAGER: PHONE#: FAX#: <br /> SAMPLER NAME: <br /> edl'" ,` Islpnaturel <br /> TAT(Analytical Turn Around Time) 0-Same Da)r1 =24 Hour, 2-48 Hour, (Etc.) ¢ m <br /> CONTAINER TYPES: 13=Brass,G=Glass,P=Plastic,V-Voa Vial,0-Other LO N <br /> SAMPLE DATE TIME MATRIX CONTAINER Go SAMPLE CONDITION/ <br /> NO. SAMPLED SAMPLED SAMPLE DESCRIPTION WATER say SLUDGE MIER TAT r TrPE COMMENTS: <br /> 13 V0 X I / <br /> H- 7 i�/9, /j; X Q <br /> Myj 171 L/ <br /> ol <br /> RetwKmst,ed Sy:)Srynature and Primed ame) Received 8y.(S" stare and Pdnted Name) Data: Time: SAMPLE DISPOSITION: - <br /> ,� ;' / <br /> � only r.. �p 7 f • � rs� n ). Samples returned to client. YES NO., <br /> ReMngV W By:[Sgnature and Prir,red Name) Received By:(Signature and Printed Mame1 Date: Time: w <br /> (/ I 2. Samples will not be stored over 30 days,unless <br /> Relnquisned By:ISgnature and Printed Name) Received By:(Signature and Printed Name) Dare: Tirrm additional storage time is requested. <br /> 3. Storage time requested: —.--.------days <br /> SPECIAL INSTRIr^*IONS: <br /> �. DISTRIBUTION:WHITE,YELLOW, PItllt TO SECO—GOLD TO CLIENT <br />