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CHAIN OF CUSTODY AND <br /> SMITH EMERY COMPANY # ANALYSIS REQUEST <br /> The FuU Serwr Independem Testing f.iNmiory FsluNished IW4 604 <br /> 781 East Wash,nglon Boulevard • Los Angeles Calsfomta 90021 • (21 l 749 341 1 • Fax (213)743 6372 DATE r % PAGE_ OF <br /> P O Box 890550 Hunter s Pont Shipyard Bldg 114 • San Francisco California 94188 • (4 3]0 3000 • Fax (4l5)622 306 , <br /> i 5427 East l a Palma Avenue • Anaheim California 92807 • (7 i 694 1026 • Fax (714)693 103 FILE NO IAB NO <br /> CLIENT NAME $ * 0 ` � _ C ,_1 ANALYSES REQUESTED. ';. REMARKS: <br /> PROJECT NAME" PROJECT NO 2, PO NO g <br /> Asea 8�1� <br /> F <br /> ADDRESS ;x � <br /> ��a33�as 1 <br /> l � <br /> PROJECT MANAGER.AA i o GO% Q PHONE# FAX# r <br /> c75 <br /> �JJ G� 10 CIA 74 <br /> SAMPLER NAME <br /> rAT(Analytical Tum Around Time) 0-Same Day, 1 -24 Hour, 2-48 Hour, (Etc) <br /> z <br /> "ONTAINER TYPES B-Brass.G-Glass,P-PlaStic,V-Voa Vial,0-Other I <br /> SAMPLE DATE TIME KATPJX SAMPLE CONDMONI <br /> NO SAMPLED SAMPLED SAMPLE DESCRIPTION WATM WIL SLUM cTMEN 7AT a rr�a COMMENTS' <br /> (Mw 5 3"llf- )Or 12. V <br /> M\W 531.94 11:4 o <br /> Mw �# S•31�9� ►f �1� �l X X <br /> MW 5'31.1 x- 10: 50 2. V <br /> MWS s•31 10:40 V ` <br /> t <br /> Ref (spnaare and ! � � raecerved By( eve a and Prkaed Name] ' Data Tim* SAMPLE <br /> DISP[uOSIT �OolClient7 YES NO <br /> ts;��Q (i2!2t= <br /> RWwwa had Or(S,pnsAre and I Received By(Signature ruedI I Delo Time� P Samples will not be stored over 34 days,unless <br /> +lecewed Bir(Sgnawre and Pnnted Namal �" Data Tis,p additional storage time is requested <br /> Rahnqu�r,ed er lam•and Printed Nana] <br /> 3 Storage lime requested days <br /> SPECI jL INSTRUCTIONS By Date <br /> 9 DISTRIBUTION WHITE,YELLOW, TO SEGO T GOLD TO CLIENT; y— 0 <br />