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• ASSOCIATED LABORATORI40 <br /> 806 North &Ttavia e Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 LM\ <br /> Company—',c�.f�/ r^ 3:37-- <br /> {� h i <br /> Project Mana er�` O , C— � A n �G "G" —3 v A L Job No q3 Q u"5 Page of <br /> g i� � �r r�U�Uj"l Fax �6 : .V -,Yrj,�0 Analys€s Requested Test Instructions & Comments <br /> Project Name �a Project M !�� T" <br /> Site Name / f <br /> and <br /> Address <br /> OV-0 C „Y--Z)i"1 C44, q3'ry ^� P T <br />' Sample ID Lab ID Date Time Matrix x Number/Size Pres P) <br /> r lett. r� �0,20 G <br /> 4 w 2f� 10-40 K <br /> - Vw 2� ,Id: NXS -oz <br /> * vw <br /> u14�d ,t�; }< <br /> w 5� f(�=30 XXX <br /> v w <br /> 8 <br /> 9 <br /> 10 <br /> 1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished tsy�6� I Rellnquishe � � Relinquished by 3 <br /> Sampler <br /> V v rs <br /> Tota;Number of Containers Property CooleN/ A Signatu Signature Signature <br /> Custody Seats Y N NA ` Samples Intac Y/ /NA Printed Name Printed Mame Printed Name <br /> Received in Good Condition Samples Accept Y/ Date Time /?,-tQ0 Date Time Date Time <br /> k c15 2cv.62- <br /> Turn Around Time Roe t;dr 1 5/� 1 Received By 2 Received By 3 <br /> � Signature i� Signature Signature <br /> (J Normal ❑ Rush 0 Same Day ❑48 hrs Printed Name Printed Name Printed Name <br /> ❑24 hrs L)72 hrs <br /> Date Time Dater Time q o Date Time <br /> Distribution White Laboratory Canary Laboratory Pink Proleci/Account Manager Goldenrod Sampler/Originator S l� <br /> `- <br />