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ASSOCLATED LABORAToru__ <br /> 806 North Batavia • Orcmcge, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 . Fcrx (714)538-1209 <br /> Company7_ r n , 0' 1— c�. Pho �13 j� g /�3�g A L Job No Page of+ <br /> Project Manager ~-�✓ Fax d <br /> _tU P-L, Analysis Requested Test Instructions&Comments <br /> Protect Name �,p� �� � Pro t q Site <br /> �y� �^ �] ]�,� <br /> and Name K P4��r c 4 YF 4' [ Ll I"f <br /> Address St;Z, c!"J ZO,7-- P f `� <br /> �t tIJJ N <br /> Sample ID Lab ID Date Time Matrix Container <br /> Number/Size Pres X , <br /> r <br /> 1 FSI,U 1 03 11 03 dZ I4 P,_ ) T?044,- Node X }C <br /> 2 iNEIV& v 3 13 06 424 3 I 2- /17r_-h t,+P_ No6(r- 5c <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> g <br /> 9 <br /> 10 <br /> 77 <br /> 71 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished b�t�+ 1 Helmc�wshed b�1f� � 2 Relinquished by 3 <br /> sampler �lGt L�+ l �� <br /> Total Number of Containers y Property Cooled Y/N/NA Signal Signature Signature <br /> ur <br /> Ncv <br /> Custody Seals Y/N/NA T Samples Intact Y!N/NA Pr,nted a Printed Name Pnnted Name <br /> 56 Na4cQ'104 PD8T,3 C,+_, <br /> Received in Good Condition Y!NY Date Time Iy <br /> 1 b3 V f' cJ crate Time Date <br /> Time <br /> Tuf Around Time Received By 1 Received By 2 Received By 3 <br /> "CO" <br /> Signature 9 Signature Signature <br /> ' U/Normal J Rush Q Sante Day El 24 hrs ❑72 Elhrs hrs Printed Name Printed Name Printed Name <br /> 72 <br /> Date Time Dateme Date Time <br /> Distribution Whtte Laboratory Canary-Laboratory Pink-Proiect/Account Manager Goldenrod Sampler/Ongmator <br />