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T11 EMERY COMPANY CHAIN OF CUSTODY <br /> ull5enice Independent Testing Laboratory Fitabbuhrd 1904 ANALYSIS REOUE f <br /> 781 East Washington Boulevard • Los Angeles Cahforma 90021 • (213)749 3411 • Fax (213)745 6372 DATE �� --7 3 PAGE ! OF <br /> P 0 Box 880550 Hunter s Point Shipyard Bldg 1 t 4 • San Francisco,CaIt( 94188 • (415)330 3000 • Fax (415)822 5864 —� <br /> 5427 East La Patina Avenue • Anaheim California 92807 • (714)693 1026 • Fax (714)693 1034 FILE NO 6 LAB NOL- <br /> CLIENT NAME ' G ANALYSES REQUESTED REMARKS <br /> PROJECT NAME ---h r L I<lt� PROJECT NO --- PO NO — I�fn <br /> I1 Vk le�#vs <br /> ADDRESS <br /> 1701 Wes Loi Ze /D Bs k e-rs fl',,V. d4 l�� Y�1� A 14 <br /> PROJECT MANAGERPHONE# AX# <br /> SAMPLER NAME , o <br /> / ledl (Signature) <br /> r � IlJ <br /> TAT(Analytical Turn Around Time) 0-Same Day, f -24 Hour, 2-48 Hour, (Etc) Cn Q m <br /> CONTAINER TYPES Brass,G=Glass,P=Plastic,V=Voa dal,0=Other <br /> SAMPLE DATE TIME ! MATRIX CMAINER 00 * SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION x WATM eats toes oto TAT a COMMENTS <br /> -/ -z.'K 0,4.0 DMZ- ' X I3 X <br /> 711k2 o-0 X I I I <br /> X X <br /> fi 5,z <br /> R I,rqu and Printed Na 1 Received By(Signature and Printed Name) Dale T7 <br /> Z/ "'4(�Q _ SAMPLE DISPOSITIONa 1 Samples retumed to client? YES <br /> er ngwshed gnature and Printed Name) Rece By(Signature and Printed Name) brill G`1.}f i ate Time <br /> r� <br /> Y&,31'73 /Doi 2 Samples will not be stored over 30 days,unless <br /> Reanqu55hed By(Signature and Panted Name) Received Bir-(Signature and Prin66 Name1 Dale Time additional storage time is requested <br /> TRUCTIONS 3 Storage time requested days <br /> SPECIAL INS <br /> Sy Date <br /> DISTRIBUTION WHITE,YELLOW, PINK TO SEGO—GOLD TO CLIENT <br />