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F#ferican Environmental Testines' a Laboratory Inc. <br /> 2834 North Naomi Saw Burbank,CA 91504 • DOHS NO 1541,LACSD NO 10181 CHAIN Q F C U STO DY CORD , <br /> } Tel (888)288-AE7L• (8 18)845-8200.rax (818)845-8840 <br /> I / � <br /> COMPANY �• P�� Page 11 — 1 AETLJOB No 1 i of <br /> PROJECT MANAGER J F % 1� JJ <br /> s�Q U5 U ANALYSIS REQUESTED TEST INSTRUCTIONS&COMMENTS <br /> PROJECT HAWE <br /> V ]D PROJECT# ^4 <br /> SITE NAME <br /> AND 2� T !L w i $ M <br /> ADDRESS ,--D^ 41— 4) T- 1❑ <br /> SAMPLE ID al'D DATE TIME MATRIX <br /> �o CONTAINER ARES t7" E [�] <br /> NUMBER/SIZE <br /> �$ I 05 r; 00 � �� R��� —7/T <br /> ' 0 UTG-Fay 8 :40 <br /> 1Ntr_-T g 8 .50 <br /> TB - 12-U �3� : <br /> 7-6-- 2w g :�o ?C <br /> g-- U g -60 <br /> Mw-57 fo <br /> . <br /> 17-6- lyr, /1 .20 <br /> N J <br /> SAMPLE RECEIPT-TO BE FILLED BY LABORATORY $AUNQUIISHEDBY RELINOUISHED9Y MPLER 2 JRK1NOUISHEOBY <br /> TOTAL NUMBER OF CONTAINERS PROPERLY COOLS Y!N/ A gnalwe ,gnalure <br /> �gnalure <br /> CUSTODY SEALS Y/N/ A SAMPLES INTACT N/NA P"n1°4 Name ,q_� {� Pnn1e0 Name p,Ml�N <br /> afillwir- <br /> RECEIVED IN GOOD CON D /N SAMPLES ACCEPTS Y N Bale�_ Tvne� T �,T Oar T <br /> TURD AROUND TIME RECEIVEC B��� Z�� 77,41=EIVE <br /> True <br /> 1 RECEIVED BY 2 DBYORATORY 3 <br /> Sejnarwe Signature gnalur <br /> NORMAL [� RUSH ❑ SAME DAY ❑48 HAS Qie� <br /> ❑ 24 HAS Prnlea Hama Prurle0 Name �� <br /> ❑42 HAS Prml <br /> to T,me 7 Tune Date <br /> DISTRIBUTION WHITE-Laboratory, CANARY-Laboratory, PINK-Project/Account Manager, YELLOW-Sampler/Originator <br />