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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia a Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 a Fax (714) 538-1209 <br /> 6 � <br /> Company T]j n l r r C 0 C— f, ,� Phan 5e" �� T J A L Joh No Page of <br /> Protect Manager T _ , l r Fax a [] �" E Analysis Requested Test Instructions&Comments <br /> t— t1� r1 k L ,v, tib 6 - 7 21-- P) Gid y a <br /> Project Name `, �p� • Protect# ! <br /> :3 C �L-t, CIA a�L <br /> and Site Name '� t o �- f�4 C <br /> Address `1 • Z l t( 1 0 f„f d > 2-1 eJ <br /> c � <br /> Sample ID Lab ID Date Time Matrix Container Number/Size Fres <br /> 11 <br /> 2 �'Nr�.tic�li <br /> 3 <br /> 4 <br /> 5 <br /> 7 r <br /> P <br /> ,r <br /> 72 <br /> 14 f <br /> ✓ r <br /> r <br /> 15 <br /> t-To Be Filled By Laborato Relinquished by _ t Rehr�u rd bg Relinquished by 3 <br /> Sample Receipt Sampler <br /> Total Number of Containers Properly Coaled N/ A Sag a Signature r ., 1 Signature <br /> Custod, Seals Y!N/NA Samples Intac Y/N NA Pn�teci,IVame� ', �� Panted Name Panted Name <br /> Received in Good Conditio Y N Samples Acc ed Y N Date; N� Time Date Time Date Time <br /> Turn Around Time Recr-A"I Received By 2 Received By- 3 <br /> Signatu(rl. : `c , Signature Signature <br /> L`1 Norma! Ll Rush D Same Day ZI 48 hrs Printed Name Printed Name t Printed Name <br /> ©24 hrs ❑72 hrs V- <br /> Date Time Date Time d Date <br /> I - 0 — :1 <br /> M@lloutron Idibft LabgMk=CanallidlWratoraill1i ProtUWWWunt N Gol(Jlliflksampr�nator i i 111111111 I♦ - <br />