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t� t� I� li Iii i i iIMIM MIMM <br /> SITPbIVE ANLYSIS REQUEST <br /> 781 East Washington Blvd, CHAIN OF CUSTODY A <br /> Los Angeles,CA 90021 ATE {�-, 2 ; <br /> OFF LAB ERVICE (213)745-5312 FAX(213)745-6372 LOG BOOK NO "I FILE NO LAB NO { ! € OF= <br /> CLIENT NAME T -- , >`y T ANALYSES REQUESTED AIRBILL NO- <br /> PROJECT NAME j t•-.._ � � _t r� r PROJECT NO �I � _ _ � PO NO <br /> COOLER TEMP: <br /> PRESERVED. <br /> ADDRESS -,�`� r j �, t ` , 1 T ) .el REPORT <br /> - la <br /> PROJECT MANAGER -�, ,,r PHONE NO FAX NO LEVEU <br /> _ � 1 <br /> SAMPLER NAME {,fes_�. A ,.�.. Piz I' REMARKS <br /> ` (Ponied) {Sign�4ure€ 1 <br /> k� <br /> TAT(Analytical Turn Around Time) 0=Same Day, 1 =24 Hour, 2=48 Hour, (Etc)r N=K�RMAL r. <br /> CONTAINER TYPES B=Bran,G=Glass,P-Plastic, V = VOA Ylal,0=Other r <br /> f r <br /> SAMPLE DATE TIME MATRIX CONTAINER Gr v SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WAVER sow uFX7E OTHERTAT I 1COMMENTS. <br /> r _ <br /> j F <br /> _ F <br /> Iry- <br /> ti <br /> 0 <br /> P4*Wa13y <br /> uisha gnalure and P need N e) Received By(Si �Pd Da , SAMPLE DISPOSITION <br /> rI��•`F\ I t I 1 Samples returned to client) YES <br /> {Signature and'i'nnted Name€ Received By(Signature Pr ed Narrta) pate Time <br /> 2 Samples will not be stored over 30 days unless <br /> %%m%%taisBy[Sgnatu,e and Printed Name) Received By(Signature and Printed Namel Date Tuna additional storage time is requested <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS <br /> �, <br /> IBY Date ---- <br />