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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange, CA 92868 dAM\ <br /> Chain of Custody Record - L Phone: (7141 771-6900 ■ Fcxrc: (714)538-1209 <br /> h�4�� <br /> Compact Phone C — l of_� <br /> Q on Z S A.L.Job No. <br /> Project M2arnrrag�er— X -- Fax CS%-L:) _?SW Analis Requested Test Instructions&Comments <br /> Project Na1 0 ,,� c �\ �,f y �� Pro3eGi O" <br /> Site Jv �1 <br /> and Name �. � <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres. <br /> ,� (a <br /> Number/Size � <br /> ' Lt,�T i�-Zl• D2 0 X55 if1: `-�ts�� 1��' '_ � �, <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> S <br /> 7 <br /> a <br /> 9 <br /> 7D <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> Sample Receipt-To Be Filled By Laboratory cretin wished by 1. Relinqttished by 2. Relinquished by s. <br /> er. <br /> Total Number of Containers Properly Cooled Y/N/NA Sign tune: Signature Signature: <br /> Printed Name Printed Name: <br /> Custody Seals Y/N/NA Samples Intact Y f N/NA me- <br /> t t. <br /> Data: tune: bate: lime: Date: Time: <br /> Received in Good Condition Y/N Samples Accepted Y IN <br /> Turn Around Time ed By, 1. JRecetvad Orr 2- Received tiy: 3• <br /> C Signature: Signature: <br /> CA Normal ❑ Rush d Same Day ©48 hrsprinted Name: Printed Name: Printed Name: <br /> 0 24 hrs. ❑72 hrs. <br /> Dat f A Time: 1� Date: 'time: 7 Date: fTime: <br /> Distribirtion: White-Laboratory Canary-laboratory Mink-Project/Account Manager t �� `~ ✓ <br />