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• 0 ASSOCIATED LABORATORIES* <br /> 806 North Batavia ■ Orange CA 92868 Z <br /> Chain of Custody Record Phone (7I4) 771-6900 Fox (714) 538-1209 <br /> Company t �.� Pho 56.2J12 ! _3� � A L Job No �> Page�__or + <br /> Proj�ainag�eri �� {��� raX !'6� z(� .�> Analysts RequestedTest Instructions &Comments <br /> ProjProt t# y ti <br /> 1 <br /> Site Name [ ' 1 <br /> and <br /> Address <br /> WP, F- <br /> Container Sample ID Lab ID Date Ttme Matrix Number/SizePres <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> „ 9 <br /> 10 <br /> 11 <br /> 12 <br /> i3 <br /> 14 <br /> 15 <br /> Relinquished b 1 Rehngw ed by 2 Relinquished by 9 <br /> Sample Receipt-To Be Filled By Laboratory sin ler 6% <br /> Total Number of Containers 2 Property Cooled Y/N/NA <br /> Signatu Signature Signature <br /> Pn%d N Printed Name Pnnted Name <br /> Custody Seals Y/N/NA Samples intact Y/N/NA p� 5rr � N papz53 t U <br /> Time A , Date Ttme Date Time <br /> Received in Good Condition Y/N q(s Samples Accepted Y/N c� Date,y.13 s x r D <br /> ReearvaFFd y RecTame <br /> 2 Received By 9 <br /> Turn Around Time M,-Z -t4 <br /> Signature SignSignature <br /> ❑Same Day ❑48 hrs Panted Name PrinPanted Name <br /> Normal ❑ Rush ❑24 hrs ❑7z hrsDate Time Dattate Time <br />