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ilii• Itl� till• Itl! illtl• !� i� tlililil! ! � � � � (♦ 1♦ � <br /> • ASSOCIATED LABORATORIE* <br /> Chain of Custody Record 806 North Batavlar a Orange CA 92868 A\ <br /> Phone (7I4) 771-6900 Fox (714) 538-1209 <br /> EPmoject <br /> Pho $� <br /> a�ager Of Fax ��Z �3L��� A L Job No V Page or <br /> G2- .C'" wJ�� Analysts Requested Test Instructions & Comments <br /> Protect Name <br /> Mo Protect p 1, V <br /> and { <br /> Site Name / p�y.��r-7 C- /I�[ lvJ� f' g i <br /> (rl <br /> Address aTZ)C,g Tz>/X ' 2-0 <br /> P r I <br /> Sample ID Lab ID Date FTI—MeTmatnx I Container Pres <br /> Number/Size x <br /> 40wr-- <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> _ 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> T4 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by �1 1 Relmgwshed by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Property Cooled Y!N/NA ! Signature Signature nature <br /> Custody Seats Y/N/NA A fb Samples Intact Y/N/NA {�/ Prutted n p� � Printed Name Printed Name r <br /> Received to Good Condition Y!NSamples Accepted Y/N ( Date 2 bZ Time Date Time Date 4 Y Time <br /> Turn Around Time Received By Received By 2acer4;d <br /> Si nature Signature Signatur <br /> 4ormal L) Rush Same Day ❑48 his Printed Name Printed Name Prin d me <br /> ❑24 hrs ❑72 hrs 1IL4 <br /> Date Time 11 D Date Time Date � DL-Time <br /> Distribution White Laboratory Canary Laboratory Pull Proiect/Account Manager Goldenrod Sarnoter/Orlainator �t <br />