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Wolzs�l <br /> flMITH EMERY COMPANY CHAIN OF CLISTO D <br /> u Fug Sewn Indepmdeu Tmmg laboratory Established 1904 /ANALYSIS REO <br /> 781 East Washington Boulevard • Los Angeles Cahfomta 90021 • (213)749 3411 • Fax (213)745 6372 PATE �( PAGE O <br /> P 0 Box 860550,Hunter s Point Shipyard Bldg 114 • San Franc sco California 94188 • (415)330 3000 • Fax (415)822 5864 <br /> 5427 East La Palma Avenue • Anaheim Caltfornts 92807 • (714)693 1026 • Fax (714)693 1034 FILE NO LAB NO 4 116 0= 0 <br /> CLIENT NAME I L1l1 .1 ANALYSES REQUESTED: REMARKS: <br /> PROJECT NAME f PROJECT NO PO NO <br /> ADDRESS <br /> 0 <br /> PROJECT MANAGER KPf �t,-,Zr PHONE# (�G� 94.3_Wt FAX# <br /> U) <br /> SAMPLER NAME /( c <br /> © OA,1� (.t,/j 1�.7tar� y) (Printed) (Signature) <br /> C <br /> TAT(Analytical Turn Around Time) 0=Same Day, 1 =24 Hour, 2=48 Fleur, [Etc M ¢ m <br /> c7 0 <br /> CONTAINER TYPES B=Brass,G=Glass,P=Plastic,V=Voa Vial,0 Other n, W <br /> SAMPLE DATE TIME MATRIX CONTAINER W C SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATER SOIL swOOE OTHER TAT a TYPE COMMENTS. <br /> uwc* c g t <br /> 11wo y <br /> t <br /> yj { <br /> Relinquished By tura nd P tad i Received By I u n rented el Date Trine SAMPLE DISPOSITION <br /> �vV�l t(,{ Y 2 1 Samples retumed to client? YES NO <br /> Relinquished By(Signature and-Printed Name) R y(S,JNwuA and Printed Name[ Date Time <br /> 2 Samples will not be stored over 30 days unless <br /> Relinquished By{Signature and Printed Name) Received By 15qnaiure and Printed Name[ Bale Time additional storage time is requested <br /> 3 Storage fame requested days <br /> SPECIAL,INSTRUCTIONS <br /> By Date <br /> DISTRIBUTION WHITE,YELLOW, PINK TO SECO—GOLD TO CLIENT <br /> A <br />