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CHAIN OF CUSTODY AND <br />POSITIVE 781 East Washington Blvd., ANALYSIS REQUEST <br />Los Angeles, CA 90021 DATE — _ _ -__ __ PAGE- ----OF--., <br />LAB SERV 1 C E (213) 745-5312 FAX (213) 745-6372 LOG BOOK NO.__ FILE NO _—__ LAB NO Z �_✓� <br />CLIENT NAME. P <br />ANALYSES REQUESTED: <br />AIRBILL NO: <br />COOLER TEMP: � <br />PROJECT NAME: PROJECT NO. P.O. NO, <br />�. <br />PRESERVED: <br />ADDRESS <br />.,..F. <br />— <br />QC REPORT <br />LEVEL: <br />PROJECT MANAGER: PHONE NO:(z13) FAX NO:('tt3)-1 i5 1L31 2- <br />REMARKS: <br />)Printed) iSignalwc) <br />._ <br />,J <br />TAT ;Analytical Turn Around Time) 0 = Same Day: 1 = 24 Hour, 2 = 48 Hour, Etc.) N = NORMAL <br />v <br />CONTAINER TYPES: B = Brass, G = Glass. P = Plastic, V = VOA Vial, 0 = Other: <br />SAMPLE CONDITION <br />SAMPLE <br />DATE <br />TIME <br />MATRIX <br />COtJTANER <br />WATErisou. <br />swdcE <br />oT En <br />a vpPe <br />NO. <br />SAMPLED <br />SAMPLED <br />SAMPLE DESCRIPTION <br />TAT <br />COMMENTS: <br />1 <br />09(t'lli's <br />OAC "� <br />►1 C �.:2� l ,i.,C �'� 1Cc� <br />N <br />1 <br />/ <br />f <br />Rel <br />sn 1 By IS'yn.alu and Pnnled Name) Received By IS gnature and Printed Namel e _ 1""e. <br />��,.... N h-5 1 i 3 <br />SAMPLE DISPOSITION: <br />1. Samples returned to client? YES NO <br />2 Samples will not be stored over 30 days. unless <br />Rehngu,shed By I(; nature and Printed Name) Received By (Signature and Printed Name) Dade Tone <br />additional storage time is requested. <br />Relinq;ashed By l&ynature and Printed Name) Received By ISignalure and Printed Name) n,,t„ fin" <br />3. Storage time requested days <br />By -- - - Date <br />SPECIAL INSTRUCTIONS: <br />DISTRIBUTION: WHITE. YELLOW. PINK TO LAB — GOLD TO CLIENT <br />