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ASSOCIATED LAEORATORMLAChain of Custody Record <br /> 806 North Batavia-Orange. CA 92868 Lab Job No. <br /> Phone;(714)771-6900 a Fax:(714)538-1209 Page —,I — of �..— <br /> CUSTOMER INFORMATION PROJECT INFORMATION REQUIRED TURN AROUND TIME: Standard: <br /> COMPANY PROJECT NAME: c 72 Hours: 48 Hours: 24 Hours: <br /> , <br /> SEND RE T ,J NUMBER: <br /> EMAIL: LID, ADDRESS: ' 1 �y <br /> ADDRESS: US" K 0(11111__0 <br /> P.O.#: 5 Y7 O O <br /> PHONE: / 2 SAMPLED BN. �y N <br /> Sample ID Date Time Matrix Container Pres. ` o N <br /> Number/Size Test Instructions&Comments <br /> 1 _M- l lO:t)0 l strltp Ice / <br /> 4 lots o W <br /> N <br /> 5All <br /> CC W <br /> 8 m Q= <br /> 7 �J <br /> 8 = <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> • 14 <br /> 15 <br /> Total N.9.of Samples: Method of Shipment: Preservative: 7= Ice 2 =HCI 3 =HNOS 4 =HZSO4 5 =NaOH 6 =Other <br /> Rell hod by 1. Received By: 1. Relinquished by 2. Received By: 2. Relinquished by 3. Received By: 3. <br /> Sig Si Signature: Signature: Signature: Signature: <br /> C <br /> d U Ne e:�j ,A1 Printed N e: Printed Name: Printed Name: Printed Name: Printed Name: <br /> ate: Time: Dat : Time: Date: Time: Date: Time: Dale: Time: Date: Time: <br /> f � <br /> Distribution: # <br /> -Laboratory Canary-Laboratory Pink-Prolect/Acceunt Manager Goldenrod-Sampler/Origlnalar• • <br />