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SMITII-EMERY COMPANY _w- <br /> Th,Frdl Service Grdejrenderu Teshirg f vbOrarory,EsrabArhed 1904 <br /> 781 East Washinglon$rru]evard CHAIN OF CUSTODY AND <br /> !'.0.Box 880550,Hunter'sPoint Shipyard$ld 1 14 Los Angeles,California 90021 AN LYSIS REQUEST <br /> 5427 Fast La Palma Avenue 8' San Francisco,California 94188 • (213)749-3411 • Fax:(213)745-6372 <br /> • Anaheim,California92807 • (415)330-3000 • Fax:(415)822-5864 DATE: 7 1 ' PAGE OF <br /> CLIENT NAME: (714)693-1026 • Fax:(714)693-1034 FILE NO. 7,1q f LAB NO. n/ S 7 `f el t) 1 <br /> PROJECT NAME. ANALYSES REQUESTED: REMARKS: <br /> ADDRESS: PROJECT N0, P.O.NO. <br /> PROJECT MANAGER: /? <br /> (jos} <br /> SAMPLER NAME: Set —a G FAX <br /> LU <br /> (signature] o <br /> TAT(Anal)rtical Turn Around Time) 0=Same Day; 1 =24 Hour, 2=48 Hour, (Etc.) 0 <br /> Cn <br /> CONTAINER TYPES: g=grass,G=Glass,P=Plastic V= N <br /> SAMPLE DATE Voa Vial,0=Other: <br /> TIME cn m <br /> NO. SAMPLED SAMPLED SAMPLE DESCRIPTION AAATRIX <br /> *— N GD <br /> CONTAINER OO' S v SAMPLE CONDITION/ <br /> WATER sore DOGE OTHER TAT <br /> N� 7/� 9. �` COMMENTS: <br /> 30 <br /> I is • � /.� fit, <br /> X � <br /> Rein quished By:t$ignalure and Printed a e] <br /> `J <br /> Received <br /> r. By.(Si�nature and Printed Name) <br /> Relinquished H: r.-- .' ... 7/!.1�9� �- Date: Tune: <br /> Y(Sig and printed Name] SAMPLE DISPOSITION: <br /> Received gy:ISignaNre end Primed ya ] oN�r r.. rp 7 /J n 1. Samples returned to client? YES r�0 <br /> Reiff ✓ me Date: <br /> squished By;lSignature and Printed Name1 / Time: _ <br /> Received eY 2. Samples will not be stored over 30 days,unless <br /> (Signature and Printed Name] additional storage time is requested. <br /> SPECIAL INST�`'" t Date: Time: <br /> -ONS: <br /> 3. Storage time requested: days <br /> _ DISTRIBUTION:WHITE,YELLOW. PINK Tn crr+n __ _-.____ Byr ;ate <br />