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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 <br /> Company �p� Phone�-� t7f C' <br /> A L Job No Page of <br /> Project Manager Fax , <br /> Analysis Requested Test Instructions 8 Comments <br /> Project Name �J' Projec p j ��yy/± �^� <br /> Site Name ►` , r,� „ ` -7 06o ljoC)6 v <br /> and <br /> Address <br /> Container CL <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres C` P as <br /> fl i <br /> 3 MLU _ ti <br /> 4 !\`t'v r 14 �<,>< x <br /> 7 kw <br /> s � <br /> ��`Wr <br /> 2 V oil t4u, X ><I T-Z <br /> 10 <br /> 11 m- <br /> 12 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished b1r 1 Rehmhe b Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Z Properly Cooled Y/N/NA Signatur Signature 0 Signature <br /> �� a 0 A. t q r 6-10t <br /> Custody Seals Y I N/NASamples intact Y/N/NA Printed Na a Pnnted Name Printed Name <br /> tY't�- <br /> Received to Good Condition Y/N Samples Accepted Y/N Dat Time r Date Time Date Time <br /> --2o 0 3 <br /> Turn Around Time Rec 14., � � Received By 2 Received By a <br /> ' Signatureb L n t�j Signature Signature <br /> dNormal Ll Rush El Same Day ❑48 ht's Printed Name Panted Name / Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date Time Date line <br /> Zed 21 -- <br /> Distribution <br /> Distribution White Laboratory Canary Laboratory Pink Proiact/Account Manaaer Gnklenrod SamnO-1O 1na}nr <br />