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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia ■ Orange CA 92868 <br />` Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company 7-�/r�, Q 1 7 .(r A L Job No rt rfl Page of <br /> Project Manager Fa <br /> �U A Pa �16�Z Analysts Requested Test Instructions &Comments <br /> Project Name5 W 7 Protect M <br /> Site <br /> Name 7 �G( �� jc`mss ` <br /> and <br /> f� <br /> Address ,7- <br /> Container <br /> Sample ID Lab ID Date Time Matrtx Pres <br /> Number/Size <br /> 2 EF(-iwet- k9 nZ 1120 A R /TT lAP— Noir X X <br /> 3 / <br /> 4 <br /> 5 j <br /> 6 / <br /> 7 <br /> t3 <br /> 9 <br /> 10 <br /> 12 <br /> 131 <br /> /r <br /> 14 <br /> I <br /> 15 1 IT <br /> Relinquished by 1 Relinquished y 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler `�-Rglh'( Grju4�g - <br /> Total Number of Containers Property Cooled Y/N/NA tf Signature Signature Signature <br /> Custody Seals Y/N/NAS Samples Intact Y/N 1 NA II Q� Printed N �J Printed Name Printed Name <br /> Dat/e?n 1� Time Date Time Date Time <br /> Received m Good Condition Y 1 N Samples Accepted Y/N )2 <br /> Turn Around Time Received By 1 Received B Received By 3 <br /> G�3l dt n� 34F Z <br /> Signature Signature Signature <br /> t I Nopmal ❑ Rush C3 Same Day 0 48 hrS Pnnted Name Printed Name Printed Name <br /> ❑24 hrs ❑72 hrs &I&Nq _A11111111111, <br /> Date Time Date r �G� Time o � Date e <br /> r....,. i aH.-t— pmY Prnlact/Arentmt rnirl—rnd-S+mnr.r{r$lninPtnr t D <br />