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I- t� (� (' ti11111111111>1 t- <br /> SSOCIATED LABORATORIES7W <br /> 806 N Batavia c Orange CA 92868 �{�� J CHAIOF CUSTOD CORD <br /> (714) 771 6900 ® FAX (714) 538-1209 Date i Z t'-y, GGA Page__ of <br /> CLIENT16�0yo ESE <br /> / PROJECT MANAGER <br /> ADDRESS p-7s H&6-r fjeoC-k(�R ►Z� So�ZZ„p RR / Samples Intact Yes No <br /> `OZK 13�t�Zot;'�'p` County Seals Intact Yes No <br /> N c[L(6x( PHO ICER `�;6 <br /> Sample Ambient Cooled— Frozen <br /> PROJECT NAME SAMPL (Signature) Same Day 24 Hr <br /> Regular� 48 Hr <br /> SAMPLE TYPE <br /> SAMPLE LOCATION ATE Ti NO OF SUSP <br /> GNTNRS CONTAM TESTS <br /> NUMBER DESCRIPTION w,TER AIR SOLID REOLI RED <br /> o�rtt►w-iz <br /> 12,CZ <br /> tG Z- <br /> 0f'1`►w — fq iti�Z 13� <br /> SRO <br /> Rehnq is ed by (Signat a Received by (Signature) Date/Time I hereby authorize the performance of the above <br /> Indicated work <br /> Re quashed by (SI ature) Rec o I Date/Time <br /> {sig � �cvu <br /> Special Instructions <br /> DISTRIBUTION White with report Yellow to AL <br /> Pink to Courier <br />