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SMITH EMERY COMPANY CHAIN OF CUSTODY AND <br /> Vie Full Smax lndTendmi Tiymg Laboratory Esrab h-W 1904 _a ANALYSIS REOUEST <br /> 781 East Washington Boulevard • Los Angeles,Califorma 90021 • ( 3)749 3411 • Fax (213)745 6372 DATE - g A PAGE _�__OF—� <br /> �Q p Box 880550 Hunters Point Shipyard Bldg 114 • San Francisco,California 9418$ • ( 1 5)330 3000 • Fax (415)822 5864 `t <br /> 5427 East La Palma Avenue • Anaheim California 92807 • ( 4)693 1026 • Fax (714)693 1034 FILE NO A9 NO U 1A <br /> CLIENT NAME. 0c, € ANALYSES REQUESTED., REMARKS*A a R B t4 if <br /> r <br /> PROJECT NAME PROJECT NO 7 Z PON 2.q t 11 ci0 7.8 q <br /> ADDRESS C y <br /> PROJECT MANAGER/�/� L CSB HONE# FAX# , W <br /> w 1 <br /> SAMPLER NAME E V CiE7 I M--� o <br /> (N�dl �gnalure] 1 <br /> TAT(Analytical Tum Around Time) 0-Same Day, 1 -24 Hour, 2-48 Hour, (Etc) r Q m <br /> CONTAINER TYPES B-Brass,G-Glass,P-Plastic,V-Voa Vial,0-Other t "' <br /> SAMPLE DATE TIME MATRIX CONTAINER m to SAMPLE CONDITION/ <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION warn SM L-u Oman TAT s TYPE COMMENTS. <br /> I <br /> hW1 �r1 cry 12 b0 'A <br /> �w $Ii,5i 2.3 d r ;- 1� i t 'jkst <br /> taw g ►, 14 r 4. 2 <br /> �tw . <br /> 8.15 ,1t+ II' 2- <br /> M\09 <br /> M\09 •45 12 4o 2 x x <br /> 'AVON X <br /> r <br /> Re By-ISgr atufF anqPm1eb I Received By(Signature and Printed Name) ) Date Time SAMPLE DISPOSMON <br /> I Samples returned to client? *YES NO <br /> Relrnq a re and PnMm <br /> ed Name) Received By(Signature and Printed Nael Date Time 4. <br /> 2 Samples will not be stored over 30 days,unless <br /> Ret nqueshed By-(Signature and Printed Name) Received By(Signature and Printed Name1 Date Tine add*onal storage time is requested <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS <br /> lay 1 _ Data <br /> DISTRIBUTION WHITE YELL NK TO SEGO—Gni 0 TO CLIENT <br />