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'"'"; F7 t"�l r" �'"""' ."""""� Imo! 1 17777 �"*} l"*t r07 r7 ;�. „ 177" <br /> ASSOCIATED LABORATORIES <br /> 806 N. Batavia• Orange, CA 92868 CHAN PF CUSTODY RECORD <br /> (714)771-6900,9-FAX:-(714) 538-1209 \ Date Page Of <br /> CLIENT <br /> PRgECT M A N A ER <br /> ADDRESS f/ t 'fes Samples Intact Yes No <br /> L County Seals Intact Yes tato <br /> —] PHONE NUMB r //' Sample Ambient Cooled� Frozen_ <br /> PRnnn"""iir���CT NAME SAMPLERS: turel (?'{ Same Day 24 Hr. <br /> iJ <br /> Regular 48 Hr. <br />• _ <br /> SAM P� NO,OF SIJSP. <br /> SAMPLE LOCATION PATE TIME CNTNRS. CONTAM. TESTS <br /> NUMBER +rDESCRIPTION- WATER AIR SOLID REQUIRED <br /> + r _ <br /> G <br /> 441 <br /> _j <br /> Rel+ quishe b .{Signa re) VReelved <br /> d ignature) D to/Time] here y authorize the performance of the above <br /> lLrk[ qka <br /> Rel' quished by:(Signature) by Laboratory for analysis: Date/Time <br /> (Signature) <br /> Special instructions: <br />� DISTRIBUTION:White with report.Yellow to AL, <br /> Pink to Courier <br />