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i ASSOCIATED LABORATORIE0 <br /> 806 North Batav2a ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> �� 36�`Y <br /> Company �r1 / f r-; �� Phon Gla 12/ 7 6 0�1 A L Job No Page of <br /> Prosect Manager h�I l i I �n e J Fax <br /> 5-60 (dig �'�3 Lt ! Analysis Requested Test Instructions &Comments <br /> Project Name r � 1 ^t Prot t M <br /> and SiteName � P4 f f C -9-1!ic, � y <br /> Address r � , a� ,.,_rl 6-2v <br /> r,t (,j}+- P E � <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> X + <br /> W <br /> 2 //-� <br /> POP? O)CY o-F N,�� <br /> IY <br /> B Vl1 9 <br /> w W / Int� ►9 t�o� <br /> ° r - 4 � rl <br /> 12 <br /> 13 . <br /> 14 <br /> 15 <br /> ReliSample Receipt-To Be i=dled By Laboratory Sampler by� l Relmquished�t}y �2 Relinquished by 3 <br /> Sam ler <br /> Total Number o1 Containers Properly Cool Y N/NA Signature Signature Signature <br /> Custody Seals Y/6)NA Samples Intact Y/N/NA Pruned Name Printed Name Printed Name <br /> Received in Good Con T,1, Y N Samples Accept Y N Date Time ) Date Time Date Time <br /> Li.22A��- r( <br /> Turn Around Time Recerrga t... Received By 2 Rece, 3 <br /> Signature Signature ignature <br /> ['Normal ❑ Rush ❑Same Day ❑48 hrs Pnnted Name Printed Names„ h b V� Printed Name <br /> ❑24 hrs Ll 72 Ctrs �� V <br /> Date Time Date y T,meQ S Dat}_ T; T <br /> O1str,butwn White Laboratory Canary Laboratory puiik Projeci/Account Manager Goldenrod-Sampler/Onginator <br />