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ASSOCIA TED LABORA TORIES %, <br />IZAA - Date 1 a "1 t Page of <br />806 North Batavia •Orange, California 92868 { ) . a + _� �C_',�l �� j'�,�� <br />Phone: (714) 771-6900 • Fax: (714) 538-1209 v J �/ <br />CHAIN OF CUS TOD Y RECORD Assigned LR# <br />PROJECT IDENTIFICATION/I ATION: SAMPLE TURNAROUND TIME: <br />CLIENT: ��-t � Ct �il� / I �_ GC.i'�� <br />—T Requested Turnaround Time (CIRCLE ONE)* <br />ADDRESS (j ( I 1` QAC( pr e—f� Priority Charges Apply to Rush Turn Around Times <br />PURCHASE ORDER #: I / Q \'— / 1_ RUSH: Same Day 24 Hr 48 Hr 72 Hr <br />V v J 1 STANDARD: Standard TAT **(5 to 10 Working Days) <br />Is this the ad ss the final report is to be sent to? Yes No SAMPLER: (Print AND Sign) Other <br />If "No" list mailin& address in "Special Instructions" section at the 'Availability of Same Day/24/48/72 Hr TAT Varies Based Upon <br />bottom of this Chain of Custody.Test Method Requirements. <br />**Standard TAT Varies According to Analyses. <br />CONTACT PERSON: <br />SAMPLED BY (Circle One): <br />Sample ID <br />Client Assoc. Lab Personnel <br />_ oturtr LB l.UINU111UIN IV <br />PHONE #: (3k V) J 1 , (✓ Samples Intact: Yes <br />FAX #:Sample Seals Intact: Yes <br />( -� L n ) - C2 Cooler Seals Intact: Yes <br />Sample or Location Description Date Time Matrix (See # of <br />Codes Below) Containers Preservatives <br />Q _ V. 1 t 1 yp <br />Vim. v� IN. <br />MATRIX: GW=Ground Water DW=Drinking Water WW=Waste Water <br />Relinquished by: (Print AN i )••• <br />i^a 1 Received BY (Print, <br />(Print AND sign)••• - (r - <br />Received By: (Print AND <br />Relinquished by: (Print AND Sign)... R iy4 by Lab for Analysis: <br />(ftW AND Sign) <br />)-F R LAB USE ONLY. <br />No <br />No N/A <br />NQ N/A_�,, <br />Test Required <br />{ n <br />S=Solid/Soil A=Air L=Liquid E=Food (Use the codes shown here to identify the matrix above) <br />1 Date/Time:4 LLS� Special nstructions: <br />Datelfime:�• o �C. / I <br />Datelrime: <br />***By -signing this Chain of Custody you COC DISTRIBUTI <br />are authorizing the analyses shown above. (Prins AND Sign) White with report. Yellow to AL. Pink to Client's Courier. <br />