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4 i <br /> SM>IT� C'MERY COMPANY ; CHAIN OF CUSTODY AND <br /> 7hrFlndrpendrnrTesfutgLjlx,rufvry Fctahluhall9(1! ANALYSIS REQUEST <br /> 781 EatIPWashington Boulevard a 1 as Angeles Cahforinia 90021 a (213)749 3411 a Fax (213)745 6372 DATE <br /> PO Box 880550,Hunters Point Shipyard Bldg 114 a San FranciSLo California 94188 0 (415)330 3000 a I•ax (415)822 5864 -}} <br /> 5427 East La Palma Avenue a Anaheim Cahfornia 92807 a (714)693 1026 • 1•Ax (714)693 1034 FILE NO "7.1 LA NO <br /> CLIENT NAME O G f p ANALYSES REQUESTED REMARKS' <br /> PROJECT NAME PROJECT NO 171 PO NO <br /> ADDRESS <br /> PROJECT MANAGER `I41C'f1142t�t 2]o R HONE 10 9, — N # <br /> SAMPLER NAME % W1,1 w w <br /> iPrurtedl [Signaiuret X <br /> Lt.k <br /> TAT(Analytical Turn Around Time) T-Same Day, 1 =24 Hour, 2=48 Hour, (Etc) m <br /> 0 o <br /> CM <br /> CONTAINER TYPES B=Brass,G-Glass,P=Plastic,V=Voa Vial,0=Other <br /> NWJ <br /> SAMPLE DATE TIME MATRIX CONTAINER m SAMPLE GONDMON1 <br /> NO SAMPLED SAMPLED SAMPLE;DESCRIPTION WATER sow wOGE OTHER TAT a TYPE COMMENTS <br /> 1211 <br /> r <br /> ReUrpwshed 8`y{Sgn�Su nfetl Namet '] _ it Received By IS�gn re and Printed Namel /l ' pie Trina <br /> 1 ' � 2 SAMPLE DISPOSITIDN <br /> J 1 Samples returned to chent9 YES NO <br /> Feil quashed By(Sign fore and Printed Namel Received By�Sig ure and Pr�n Name) fe _ Time <br /> rt� / I t c c _ / 1 /, r�-• �' 2 Samples will not be stored over 30 days,unless <br /> 140 cashed B nature and Printed Name additional storage lime is requested <br /> n9 Y 1�9 ) Received By(Signature and Printed Name) Nate Time <br /> L <br /> 3 Storage time requested <br /> SPECIAL INSTRUCTIONS. y <br /> IBY Date ~t' <br /> DISTRIBUTION WHITE YELLOW PINI( TO SECO—GOLD TO CLIENT <br /> AN _ - 0 - * _ z <br />