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SMITH-ENIERY COMPANY CHAIN OF CUSTODY AND <br />The fidr Sen i e btdepe„ dent Testing Linrrrun,n, Lsrran(isned 1904 — ANALYSIS REQUEST <br />781 East Washington Boulevard • Los Angeles, California 90021 • (2 13) 749-3411 • Fax: (2 13) 745-6372 DATE: PAGE OF <br />P.O Box 880550, Hunters Point Shipyard Bldg. 1 14 • San Francisco, California 94188 • (4 15) 330-3000 • Fax: (415) 822-5864 1 <br />5427 Fast La Palma Avenue • Anaheim, California 92807 • (7 14) 693-1026 • Fax: (714) 693- 1034 FILE NO. ALA i'� LAB NO. <br />CLIENT NAME: U RLIn`YCXt �� <br />ANALYSES REQUESTED: <br />REMARKS: <br />SAMPLE CONDITION/ <br />COMMENTS: <br />PROJECT NAME: �� C�lbtiaC�fvt-tt�, PROJECT N0. , P.O. N0. <br />� <br />r 0 <br />x <br />I <br />s' <br />/ <br />' I <br />_� <br />� <br />> <br />U <br />> <br />Cl/ <br />G <br />v- <br />I <br />v <br />r— <br />QQ 1 1 1' <br />ADDRESS: U�� _ . SA C- 6C Y\ �TM 0A c, <br />PROJECT MANAGER: :�kC PHONE #: 0 _q 4Z-52Z,4 FAX #: <br />SAMPLER NAME: <br />TAT (Analytical Turn Around Time) 0 = Same Day-, 1 = 24 Hour-, 2 = 48 Hour, (Etc.) <br />CONTAINER TYPES: B = Brass, G = Glass, P = Plastic, V = Voa Vial, 0 = Other: <br />SAMPLE <br />NO. <br />DATE <br />SAMPLED <br />TIME <br />SAMPLED <br />SAMPLE DESCRIPTION <br />MATRIX <br />TAT <br />CONTAINER <br />WATER <br />SOIL <br />SLUDGE <br />OTHER <br />p <br />TYPE <br />is <br />�5 <br />8a <br />:, <br />����� <br />71, <br />T1 <br />I <br />to":"" <br />inq ,shed By.( afore a Pnnteyd ame) Received By: (Signature and Printed Name) Date: Time: <br />A) 8 SO <br />SAMPLE DISPOSITION: <br />1. Samples returned to client? YES NO <br />2. Samples will not be stored over 30 days, unless <br />additional storage time is requested. <br />3. Storage time requested: — ___ - days <br />Heli cashed By: (Signature and Printed Name) Received By: (Signature and Printed Name) Dat Time: <br />Relinquished By (Signature and Printed Name) Received By (Signature and Printed Name) Date: Time: <br />SPECIAL INSTRUCTIONS: <br />DISTRIBUTION: WHITE, YELLOW, PINK TO SECO — GOLD TO CLIENT <br />