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ASSOCIATED LmoRAToRMs Chain o4 Custody Record <br /> 806 North Boto cr a Orange,CA 92868 Lab Job No. <br /> Phone:(714)771-6900 a Fox:(714)538-1209 Page __/_ of <br /> CUSTOMER INFORMATION PROJECT INFORMATION [�72 <br /> EQUIRED TURN AROUND TIME: Standard: <br /> comPANY1i-; PROJECTNAME: ^ e Hours: 48 Hours: 24 Hours: <br /> SEND fl6PURI TO' NUMBER: <br /> EMAIL: I VZNo, : (�. r ADDRESS: a5_0 A\ <br /> ADDRESS: E. �` C� c, A <br /> O <br /> PHONE' 2 q 2-I_ / SAMPLED <br /> 1 7 <br /> Sample ID Container <br /> Date Time Matrix Number/Size Pres. <br /> Test Instructions&Comments <br /> 1 <br /> T — 1/1 ff>12PA D:� Sot 15 ��\e5� IG(j <br /> 2 <br /> a :30 50,11 <br /> 4 <br /> s <br /> J <br /> �2 <br /> s too <br /> 7 Z. Uit <br /> a <br /> a <br /> �< Oc <br /> B <br /> 1 �J <br /> 10 v <br /> Z= <br /> 11 444 <br /> 12 <br /> 13 <br /> 14 <br /> 75 <br /> Total No.of Samples: Method of Shipment: Preservative: 1= Ice 2 =HCI 3=HNO3 4 =F6SO4 5 =NaOH 6 =Other <br /> Relinquished by 1. iRecivedjBy; 1. Relinquished by 2. Received ay. 2. Relinquished by 3. Received By: 3. <br /> Signa 2 Signature: Signature: Signature: Signature: <br /> 71 <br /> Pr,d Nam n ame: Printed Name: Pdnted Name: - Printed Name: Printed Name: <br /> rG_kc r, )q. O <br /> Date: Time. Datq: I Date: Time: Date: Time: Date: Time: Date: Time: <br /> I 9. z ` <br /> Distribution: ;bLabormory canary-Laboratory Pink-Project/Account Manager Goldenrod-Sampler/Originator • • <br />