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103399 <br /> AT7 <br /> POSITIVECHAIN OF CUSTODY AND ANALYSIS REQUEST' <br /> DATE:-4 -1-11 PAG F <br /> 781 East Washington Blvd., Los Angeles,CA 90021 <br /> AB SE1 <br /> (213)745-5312 FAX(213)745-6372 LOGBOOK NO. FILE NO. LAB NO. <br /> CLIENT NAME: Project Name/No. 9,\"t�- MUu t7 0.10. <br /> — 4> t �1�I AIRB L N0: <br /> q'I <br /> IUE <br /> if <br /> ADDRESS: ANALYSES REQUESTED: '" <br /> COOLER TEMP: <br /> PROJECT MANAGER:�p sa PHONE NO: FAX NO: PRESERVATIVE: <br /> N 14 <br /> SAMPLER NAME: Lk inted) (Signature) c u y A Q REMARKS: <br /> u <br /> TAT(Analytical Turn Around Time): 0=Same Day;1 =1 Da ;2=2 Days;3=3 Days;N=Normal(5-7 Working Days) N <br /> CONTAINER TYPES: B=Brass,E=Encore,G=Glass,P=Plastic,V=VOA Vial,0=Other: Z O � I Z <br /> r v �s <br /> UST Project: Y N - Global ID# <br /> MATRIX CONTAINER <br /> SAMPLE DATE TIME v s T SAMPLE CONDITION/ <br /> NO. SAMPLED SAMPLED <br /> SAMPLE DESCRIPTION WATER SOIL SLUDGE OTHER TAT # TYPE � � Q � V 41 /CONTAINER/eCOjMMENTS: <br /> 1 �ltcl� l��l ��4+C✓YI�p /3zZ El iJ/f a jVAIVZ <br /> ZI P164 Q c-1k, 11 Cd. t <br /> 2 U4 0`14WE 17 a ed Mlt o o <br /> aid � e <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> R qu'shed By:(Sign re and Printed Name) A Rec i n P' me Dat'i Time: SAMPLE DISPOSITION: <br /> If/Vi IA 4 <br /> 1. Samples returned to client? YES NO <br /> Relinqui ed By:(Signature and Printed NameT Receiv By:(Signature and nted Name) Date: Time: <br /> 2. Samples will not be stored over 30 days,unless <br /> additional storage time is requested. <br /> Relinquished By:(Signature and Printed Name) Received By:(Signature aThd Printed Name) Date: Time: <br /> 3. Storage time requested: days <br /> SPECIAL INSTRUCTIONS: By Date <br /> PRESERVATIVE:1-HNO3,2-1­12SO4,3-HCL,4-Zinc Acetate,5-NaOH,6-NH4 Buffer,7-Other <br /> LAB CORY <br />