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ASSOCIATED LAB®RATopj,Es L Chain of Custody Record <br /> 806 North Batavia-Orange,CA 92868 Lab Job No. 3 L - <br /> Phone:(714)771-6900 - Fax:(714)538-1209 Page of —4— <br /> CUSTOMER <br /> — <br /> CUSTOnlolfhMER INFORMATION PROJECT INFORMATION F72 <br /> QUIRED TURN AROUND TIME: Standard: <br /> COMPANY (t PROJECT NAME: ` Hour 48 Hours: 24 Hours: <br /> SEND REPO TO' NUMBER: <br /> EMAIL a ,M ADDRESS: a50 Al, (4At5 <br /> ADDRESS: <br /> P.O.#: 5 Y <br /> PHONE: SAMPLED BN. �y 'Y <br /> 2Q w <br /> Sample ID Date Time Matrix Container Pres. i 1 <br /> Q <br /> Number/Size % Test Instructioi�e tomWitent i- <br /> I A - a <br /> 2t A1141,11 1 1 1 <br /> 3 ;- ✓ W <br /> 4 l <br /> 5 ✓ <br /> 5 - 7-I ✓ <br /> ?-b - 3t �:2 <br /> a —Ef— tf � [ <br /> 9 ! ' ; ✓ <br /> 10 <br /> Wit <br /> t14 <br /> Total No.of Samples: ' Method of Shipment: p,► nt (Jitk Preservative: 1= Ice 2 =HCI 3 =HNO3 4 =H2SO4 5 =NaOH 6 =Other <br /> Relinquished by 1. Received By: 1. Relinquished by 2. Received By: 2. Relinquished by 3. Received By: 3. <br /> Sign4) 4 Sj Signature: Signature: Signature: Signature: <br /> Pd Iua:, A P(iota Name: Printed Name: Printed Name: Printed Name: Printed Name: <br /> U1.[1H - <br /> Date: Time: Date: Tme: Date: Time: Date: rime: Date: Time: Date: Time: <br /> DI <br /> Distribution: -Laboratory canary.Laboratory Pink-Project/Account Manager Goldenrod-sampler/Odginator� <br />