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4, <br /> ASSOCIATED LABOIZATOR <br /> LA\ <br /> U Tz- 806 North BatcMCI s Orange, CA 92868 <br /> Phone: (714) 771-6900 ■ FCIX: (714)538-1209 <br /> Chain of Custody Record <br /> AL.Job Na. Page---I—Of <br /> Company <br /> k—'Z' <br /> Fax Analysis Requested Test Instructions&Comments CD <br /> Project manager )C"-I k -7; uCZ) <br /> i 00 <br /> =C <br /> Project Nam project LJ <br /> (D <br /> Site Name <br /> and C- -7 71;." C <br /> Address <br /> y, - I CD <br /> Time Matrix Container Pros. <br /> sample ID Lab ID Date <br /> Number/Size <br /> TZ <br /> 2 <br /> t .0 <br /> UQ <br /> 4 0 <br /> 6 <br /> 7 <br /> 8 <br /> 11 O <br /> 12 <br /> 13 <br /> 14 CXD <br /> CJl <br /> 15 <br /> Relinquished by 1. Relinquished by 2. RelinquMed by 3. <br /> Sample Receipt-To Be Filled By Laboratory Sam <br /> Signature: I Signature: Signature: <br /> Total Number of Containers Property Cooled Y/N I NA ),�" — Printed Name: <br /> Printed Name; k Printed Name: <br /> Custody Seats; Y N/NA Samples Intact Y/IN I NA Date: Time: Data: Time: <br /> Date: Time:, <br /> Received in C*)od Condition <br /> ondition Y f N Samples Accepted Y N 1. Received By: 2. ReceWed By: 3. <br /> 41 ad By <br /> Turn Around Time <br /> Signature. <br /> Signatu <br /> A-9 ,�F i <br /> � <br /> LJ Same Day a 48 hrs. rintsd Name: Printed Name: Printed Name: <br /> ItiJ <br /> Normal D Rush U 24 hrs. J 72 hrs. 771. Date: Time:— <br />