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ASSOCIATED LABORATORIES LAk <br /> 806 North BcrtGnnar ° Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company 79 9 A Pho Lyr} t7 r s A C Job No Page of <br /> Project Manager �U /rF t{�'? Fax �6� �C` 3"J Analysts Requested Test Instructions &Comments <br /> if G L 3"J <br /> -40 <br /> Project Name 111 ���. �/1 Protect <br /> Site Name -kc <br /> f'� T"+! Fi L,.Irr"� �r G� y <br /> and t' �_/? $F; 1_ L <br /> Cr <br /> Address .e,.--,,,C��(��I �lh J 20 }- P r 6 f O G©4- 7 ©0�� <br /> V 7 lf�Container <br /> [`t <br /> Sample ID Lab ID Date Time Matrix Number/SizeI lb <br /> Pres <br /> C011-C Poore v as t N <br /> 13 50 X IXIA CA ergot-if4p <br /> 1 LA.)- [ = EPA keTNo t 82-60 <br /> x 2 <br /> 10 <br /> I, t-,-TB <br /> 11 5 A;)pr <br /> 12 �6� <br /> 13 -'��y <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory lgeahedJ 1 Relinquished by 2 Relinquished by 3 <br /> SamplTotal Number of Containers Property Cooled Y/N/NA Signature (�R i1 l Signature Signature <br /> Printed Name Printed Name Printed Name <br /> Samples intact Y/N/NA (� <br /> Custody Seals Y/N/NA �� Y�.S �- <br /> Received in Good Condition Y/N Samples Accepted Y/N C 1�3 Date Time Date Time Date Time <br /> Turn Around Time 1 Ric°rv°d 1 Recel+ B� 2 Received By 3 <br /> Signator Signature Signature <br /> ja5hQ Same Day E)48 hrs Pnnt me Printed Name Printed Name <br /> ormal LJ Rush p 24 hrs ❑72 hrs �4,"�W 5(1-1 <br /> . Date _0�,Time ' f1n D)e� Time Date <br /> .. . __ .... ._ _._ ......, n----- Pink P-,"VA count Manaaer Goldenrod Samoier/Oriq+nalor <br />