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� r � � � � � � ■w rl r I• <br /> CHAIN OF CUSTODY AIW <br /> AnPOSITIVE 781 East Washington Blvd, ANALYSIS REQUESyT <br /> Los Angeles,CA 90021 DATE PA"AIRBILL'NO.—L <br /> +UVLII ��Yua I <br /> OF LAB SERVICE (213)745-5312 FAX(213)745-6372 LOG BOOK NO FILE NO LAB NO <br /> CLIENT NAME ANALYSES REQUESTED <br /> COOLER TEMP: <br /> PROJECT NAME PROJECT NO PO NO <br /> PRESERVED <br /> ADDRESS �{ QC REPORT <br /> PROJECT MANAGER rr 11 PHONE FA N0 LEVEL <br /> REMARKS <br /> SAMPLER NAME <br /> v (Pnntedl (Signature) <br /> TAT(Analytical Turn Around Time) 0=Same Day, 1 =24 Hour, 2=48 Hour, (Etc) N=NORMAL <br /> CONTAINER TYPES B=Brass,G=Glass,P=Plastic, V = VOA Vial,0=Other <br /> SAMPLE DATE TIME MATRIX CONTAINER SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATER SOIL LUDGE OTHER TAT s TYPE [COMMENTS <br /> RVVr 11 <br /> 3 ��s <br /> r y -OL <br /> V AW A- <br /> Re6 ign anted N ` Received F {�igna n d Name) [e Time SAMPLE DISPOSITION <br /> 1 Samples returned to client9 YES NO <br /> =Rehnquishe3'&r4ignaiure <br /> { nature and Printed Name) Received By tS19fAtum and Panted Name) Date Time <br /> 2 Samples will not be stared over 30 days unless <br /> additional storage time is requested <br /> and Panted Name) R eared By{Signature and Panted Name) Date Time <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS 113y Date <br /> LAB COPY <br />