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I <br /> ASSOCIATED LABORATOR14 <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (7I4) 777-6900 = Fax (724) 538-I209 <br /> Company r1 ©� Ph°T6-92—)1V—3 ' A L Job No /E� t' Page of <br /> Protect Managerif � Fax 6 G(2.(r- �� Analysis Requested Test Instructions&Comments <br /> Project Name ^ C� Protect# /y <br /> Q . J 1 rr' f � N <br /> Site Name �� <br /> and f[ 4— j"'!�J L/G <br /> Address �-- �q � ��"'�[! <br /> plq <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres <br /> 3 <br /> VW-2l <br /> .04 W-2-911130 <br /> r3 , <br /> V uj,6- ' <br /> 7Ix 'X <br /> wr�-g zF.� <br /> AA <br /> 9 <br /> ,o <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Sa plefshed by 1 Rehnquy�e bQ�� ? Relinquished by 3 <br /> Total Number of Containers Properly Cooled Y I N/NA Signatur Signature Signature <br /> t Seals Y/N I NA Samples Intact Y I N I NA Printed Na e � Printed Name Printed Name <br /> Custody D <br /> i <br /> n Date �� Time a Date Time Date Time <br /> Received in Good Condition Y l N CP!-� Samples Accepted Y/N 5 <br /> Received y 1 Received B 2 Received By 3 <br /> Turn Around Time (p�gjz$ j v' <br /> Signature Signatu Signature ' <br /> ❑Same Day ©48 hrs Printed Name Pnnte me Printed Name <br /> 8/Normal RUSK ❑24 hrs ❑72 hrs My <br /> Date Time Date C�3r,1lY t�^ Time 16 4 Date Time <br /> Distribution. White-Laboratory Canary-laboratory Pink Project/Account Manager Goldenrod SampierlOrigtnator y <br />