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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 ■ Fax (714) 538-1209 LA <br /> Company?���I r 1m,j,rL C4 Phon C6c— ,6-S Q U— 2�tu A L Job No l Page of <br /> Protect Manager ..er '3 v1G /�� �V �+� PFax1 1 2J-8J54V Analysis Requested nested Test Instructions&Comments <br /> Protect Name (� � h�'{q a Proteci IE y rt <br /> Site Name <br /> and �" <br /> 6 1Gf f( rr4 <br /> Address 57-ocw-7-or4 ^ 66-2-01 ,tJC <br /> Sample ID Lab ID Date Time Matrix Container Pres - <br /> Number/Size <br /> 2 V W — 21� X <br /> 3 VW r50 X x VQ- gA5 <br /> 4 <br /> Q- <br /> 4 v W —3) 10100 0 �C V W - <br /> s <br /> VW --its W- X. X U)-:51 <br /> 9 J W,-. 6-B �K /K ?� <br /> 1D V W 6c ��� - <br /> w <br /> 1" V W-. Aik l alo Y'- 95 <br /> W - 69 )e Y, <br /> 13 V W— cc, A1j 'x <br /> 14 IIC- X ?S <br /> x x <br /> Sample Receipt-To Be Filled By Laboratory Relinquish ,�1rs r 1 Relrnquished Relinquished by 3 <br /> Sam ler wr f Crd L-W��f c3 1 I j I+7 <br /> Total Number of Containers Properly Cooled Y/N/NA Signatu -t ��� 5tgnatur 0 VF,-P KD G4�t Signature <br /> Pnnt Printed Name Printed Name <br /> Custody Seals Y I N/NA Samples Intact Y I N/NA � j <br /> Da), <br /> , Time l Date Tlme Date Time <br /> Received in Good Condition Y/N Samples Accepted Y/N .-(+jam <br /> Turn Around Time RecDva Received By 2 eceived By 3 <br /> Signature t FI Signature Signature <br /> — Y77 <br /> Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed Name f. _ Printed Name <br /> Q2 hrs L)72 hrs <br /> D Time Date Time -�V0 Dale Time <br /> Distri Whd atoryLa Pln cVAcc nt Manager Goldenrod Sampler/f3rigma r <br /> Iim r� <br />