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ASSOCIATED LABORATORIES <br /> 806 North Batavicx ■ arcmge, CA 92868 <br /> Chain of Custody Record Phone: (714) 771-6900 ■ Fax: (714)538-1209 <br /> Company 01 Phone �1 q +� <br /> %„�. A.L.Job No. Page ! of � <br /> Project Manager Fax <br /> CSL2_)°tV —IS-ILO Analysis Requested Test Instructions&Comments <br /> Project Name Project N IE 'A <br /> Site Name4 g 0 <br /> and TCC 1'7-L, �. + 0 <br /> Addresg <br /> J 00 <br /> Sample ID Lab ID Date Time Matrix Container Pres. Q <br /> Number/Size <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> iD <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be tilled By Laboratory Relinquished by 1. Rofiinquished by 2 Relinquished by 3. <br /> Sam <br /> Total Number of Containers Property Goofed Y/N/NA SignatiU4,. Signature: Signature: <br /> Custody Seals Y/N!NA Samples intact Y J N/NA rated Name; Printed Name: Prtnled Name: <br /> r0r4orrnal <br /> d in Good Condition Y/N Samples Accepted Y/N Date: Time: Date: Time: Date. Time: <br /> Turn Around Time a e' eld By: 1. Received By: z Received By: 3.n Signature: Signature: <br /> [� Rush O Same Day ❑48 hrs. tint Name: Printed Name: Printed Name: <br /> fl 24 hrs. fl 72 hrs. <br /> Dat r Time: j0 Date: Time: Date: Time: <br /> Distribution: White-Lalroratm Canary-Laba.atory Rink.Pmject/Account Manager ( ` ✓ F � <br />