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Ui ,L51 <br /> { ITH-EMERY COMPANY CHAIN OF CUSTO1D <br /> r Full Se-tce lndependew Testing Laboratory Foabhshed 1904 ANALYSES REQU <br /> l 791 East Washington Boulevard • Los Angeles California 90021 • (213)749 3411 • Fax (213)745 6372 DATE PAGE OF <br /> P O Box 880550 Hunter s Point Shipyard Bldg 114 • San Francisco California 94188 • (415)330 3000 • Fax (415)822 5864 <br /> 5427 East La Palma Avenue • Anaheim California 92807 • (714)693 1026 • Fax (714)693 1034 FILE NO _ .�LAB NO � <br /> CLIENT NAME �Ir r ANALYSES REQUESTED, REMARKS <br /> PROJECT NAME PROJECT NO PO NO tc <br /> i <br /> I ADDRESS <br /> PROJECT MANAGER PHONE#QZ,0 ?23-OA FAX# <br /> LU <br /> w <br /> SAMPLER NAME ,,,, n a <br /> Ol,0 �ff 8�+ al�j (Printed[ {Signaiurel <br /> TAT(Analytical Turn Around Time) 0=Same Day, 1 =24 Hour, 2=48 Hour, (Etc) ¢ m <br /> ca � <br /> N <br />[ CONTAINER TYPES B=Brass,G=Glass,P=Plastic,V=Voa Vial,0-Other LO co <br /> � <br /> cm eq <br /> SAMPLE DATE TIME MATRIX CONTAINER co SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATER Solt SLUDGE 4TNER TAT 4TYPE COMMENTS <br /> M 1-11WI >13 I s )QIV <br /> A'4�� a <br /> IA <br /> E <br /> 1 <br /> Rel,nquls 'S1,nalurj and P rated Name) Receive in Name bate Ti a SAMPLE DISPOSITION <br /> °1A`cjL� `'r � Z� 1 Samples returned to client? YES NO <br /> Relinquished By(Signature and Printed Name) Rec ed (SignaltAkA Printed Name{ Date Time <br /> 2 Samples will not be stored over 30 days,unless <br /> Relinquished By(Signature and Printed Name) Received By (Signature and Printed Name) bale Time additional storage time is requested <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS <br /> IBY Date <br /> DISTRIBUTION WHITE,YELLOW, PINK TO SECO—GOLD TO CLIENT <br />