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SMITH EMERY COMPANY - , 1 CHAIN OF CUSTODY AND <br /> the FuU Smwe Independent Testing laboratory EsrabbshM J` t74 ANALYSIS REQUESTt <br /> 781 East Washington Boulevard • Loi Angeles California 90021 • (26)749 3411 • Fax (213)745 6372 DATE r PAGE ,OF <br /> P 0 Box 880550 Hueter s Point Shipyard Bldg 114 • San rrancisco California 94188 • (415)330 3000 • Fax (415)822 5864 j n 7a <br /> 5427 East La Palma Avenue • An wham California 92807 • f714)693 1026 • Fax (714)693 1034 FILE NO _LAB NO - ;' `h <br /> CLIENT NAME 7~f1W 7- G L, d ANALYSES REQUESTED REMARKS <br /> PROJECT NAME. PROJECT NO Pf /7Z PO NO <br /> ADDRESS _ <br /> PROJECT MANAGER ,r'7/C fC L (CJ-9yCCJ-9y PHONE#3/!� �1 -�IlJ7(,FAX tt w <br /> rn <br /> SAMPLER NAME 7—&Osc r <br /> (Printed) {Sgnature) <br /> x <br /> TAT(Analytical Tum Around Tihe� 0-Same Day, 1-24 Hour, 2=48 Hour, {Etc M a m <br /> 0 g, <br /> CONTAINER TYPES B=Brass,G-Glass,P=PlastlC,V-Voa Vial,0=Other � ° r <br /> 14DC14MATRIX CONTAINER � ` SAMPLE CONDITION/ <br /> SAMPLE DATE TIME SAMPLE DESCRIPTIONTATS <br /> NO SAMPLED SAMPLED w,�rEa say uno[ OTHIA ! rraa COMMENTS <br /> u ,x <br /> /i <br /> l`7hl- 3o r �� z- 1r <br /> /3. / Z v /X <br /> M-11 i TT , I - A <br /> gehngwsh'°°9y IS Nre and Printed Name) Received Yy(S4gna a an Pr ted Namei Date Time SAMPLE DISPOSITION <br /> C . 7 �� >r -f','-[ /l rf ,�& 1 Samples returned to client? YES NO <br /> Rebnqust�By ISgna re Panted Name) a wed By I& lure Prs d@me) Data Tirtq <br /> -�yc .� l2 Z cp () r/ %l 2 Samples will not be stored over 30 days,unless <br /> Relinquished By ISgnatur Printed Name) Received By(signature and Footed Name) Data Time additional storage time Is requested <br /> 3 Storage time requested days <br /> SPECIAL INSTRUCTIONS. 41 <br /> By Date <br /> DISTRIBUTION WHITE,YELL PINK TO SECO—GOLD TO CLIENT <br />