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ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orange, CA 92868 LA\ <br /> Chain of Custody Record Phone (714) 77I-6900 ir Fax (714) 538-1209 <br /> Company--H O �{ Q t— i� Phone IV- � �� AL Job No Page of <br /> Protect Manager S4)plq b,f 3V�, Fax 5-6 1 -1 r A Analysts Requested Test Instructions&Comments <br /> Protect Name ,aLJ)Q Protect R / A <br /> and SiteName i-fJ lit f�Clr� fY�4rJVu.� ,t <br /> and <br /> Address ���C�Z�i T �.�`"+ ��G�L✓y ��N � � <br /> }t, �► x a <br /> Sample ld Lab ID Date Time Matrix Container Number/Size Pres <br /> 1 c oot L.—1 <br /> 2 0 r �2�I � VOA- <br /> 3 <br /> 5 k —VOA- ECS <br /> 6 MW-V 124 14 -VVA- 14C1, >� � <br /> '� 13;in � �-vol- i4 cc. � K <br /> 13. E <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished_�y 1 Relinquished y Relinquished by 3 <br /> Sample Receipt-To Be Bled By Laboratory sam ler 'i71�{ � �`�'� <br /> Sinal Signature L <br /> 5i !p Signature <br /> Total Number of Containers Properly Cool !N/NA gam" Q(f rte f � <br /> Custody Seals Y /NA Samples Inta /NA Pnnil�a��yz � Panted Name Panted Name <br /> Received in Good Con itl Y!N Samples Accepte Y/ Dat Time r Date Time Date Time <br /> Turn Around Time Recaiyed aye` �r)p-g Received By 2 Received B� 3 <br /> SigntaCtu�ovvkp !Pcr 1 Signatureff Signature <br /> Normal ❑ Rush 0 same Day ❑48 hrs Printed Name �f !R Printed Na Printed Name <br /> U 24 hrs ❑72 hrs74 <br />� V Time Date � Time DLS Ti <br /> D <br /> Dist, Whit�atary l-at- p1n4MlIliiiiillIct/Acc nagerlill"nrod JiWd0r1g j <br />