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t <br /> Am I H EMFRY COMPANY CHAIN OF CUSTODYJP <br /> I <br /> u!l Servrc a lndependem Testing Laborulan 1-Ttabkhed 1904 ANALYSIS RE QU E I <br /> East Washington Boulevard • Los Angeles California 90021 • (213)749 3411 • Fax (213)745 6372 DATE i' PAGE OF <br /> P O Box 980550 Hunter s Point Shipyard Bldg 114 • San Francisco California 941R8 • (415)330 3000 • Fax (415)822 5864 <br /> 5427 F W I i Palrn,r Avenue • Anaheim California 92807 • (714)693 1026 • Pax (714)693 1034 FILE I LAB NO <br /> CLIENT NAME _ � r r ANALYSES REQUESTED REMARKS <br /> PROJECT NAME �` lc� ! {�) PROJECT NO PO NO , %<<,� �{f <br /> ADDRESS Y< <br /> ❑ O*, <br /> PROJECT MANAGER - PHONE#, FAX II WI <br /> SAMPLER NAME -'4 >✓i r1 (7} ,]7,Z ,�G �' � 1 o <br /> (Printed) Isignatu'e� \ I <br /> LU <br /> TAT(Analytical Turn Around Time) 0=Same Day, 1 =24 Hour, 2=48 Hour, (Et) co m <br /> CD <br /> CONTAINER TYPES B=Brass,G=Glass,P=Plastic,V=Voa Vial,0=Other ` c%t°D '� <br /> m <br /> SAMPLE DATE TIME MATRIX CONTAINER m SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLES} SAMPLE DESCRIPTION WATER son SLUDGE OTHER TAT a TM COMMENTS <br /> I <br /> I <br /> l � Z <br /> Ty <br /> { <br /> { <br /> 4,ngwshed By(Signature ar(d P}Iffledg <br /> jme) Received By(Signature and Pnnted Name) tate Time <br /> ( r T SAMPLE DISPOSITION <br /> 1 Samples returned to client? YES NO <br /> Retinguished By(Signature ander rated Namel ftecerveil By(S attire and Printed Name) Date Time <br /> 2 Samples will not be stored over 30 days unless <br /> RelnMu,shed By(Signature and Panted Name) Received By(Signature and Panted Name) bate Time additional storage time is requested <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS <br /> By Date <br /> DISTRIBUTION WHITE YELLOW, PINK TO SECO—GOLD TO CLIENT <br />