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ASSOCIATED LA.BORATORM LA\ <br /> 806 North Batavlcr ■ Orcmge, CA 92868 <br /> Chain of Custody Record Phone: (7I4) 771-6900 F=., (7i�}538-I209 <br /> Gompany Phone "-? 2— O'S 11 <br /> f l Z A.L.Job No. Page of <br /> Project Manager fl Fax Analysis Requested Test Instructions &Comments <br /> Project Name . VT7l� Project a �t C- I <br /> and Site Name �} V <br /> Address1. ii=t.c— J V4...-14..TCJ� U v 1 <br /> Sample ID Lab ID Date Time Matrix Number/Size SContainePres � <br /> Nmber <br /> I/A7 '2157 50"1- YWS44e Aiere XI Yc <br /> z 1-3 3.0 <br /> d —1 -`75 - r3;i t <br /> 5 <br /> 6 <br /> T <br /> 8 <br /> 9 <br /> io <br /> 11 <br /> 1'2 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory RermquLshed by 1. Relinquished by 2. Rekngmhed by s. <br /> sampler., <br /> Total Number of Containers PrcWy Cooled Y/N!NA Signatu CL Signature: Signature: <br /> Custody Seats Y/N/NA Samples Intact Y/N/NA Prin _ rhe: Printed Name: Printed Name: <br /> Received in Good Condition Y!N SampRes Accepted Y f N Date: Ttme: Date: Time: Date: Time: <br /> 17 ao <br /> Turn Around Time L �r�t✓ 1 Received By: 2. Received By: 3. <br /> Signal Signature: Signature: <br /> Normal ❑ Rush Q Same Day ❑48 hrs. Printed Name: Printed Name: Printed Name: <br /> 0 24 hrs. 0 72 hrs. <br /> Date: Time: Date: Time: Date: Time: <br /> 00 <br /> Distribution: White-Laboratory Canary-Laboratory Pink-ProjectrAc count Manager - <br />