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ASSOCIATED LA.BORATORI <br /> 806 North Bclfcr a ■ Orange CA 928b8 <br /> Chain of Custody Record Phone (719) 77I-6900 • Fax (714) 530 8-I2Q9 <br /> Company t .L Phone 7 2 A L Job No Page_L. of <br /> Project Manager J I Fax �r•7 Analysts Requested Test Instructions&Comments <br /> SSProject Name f /'► Project# <br /> ff-6 <br /> Site Name ♦ V <br /> and r <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pr� <br /> Number/Size <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 8 <br /> I <br /> EO <br /> r <br /> 12 <br /> r. <br /> 13 <br /> 14 <br /> Sample Receipt-To Be Filled By Laboratory Sam llerh Relinquished 6y 2 Relinquished 5Y 3 <br /> ' Signatu Signature Signature <br /> Total Number of Containers <br /> Properly Coaled Y/N/NR <br /> Pned am Printed Name Printed Name <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA <br /> Date Time Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted Y/N <br /> Received 1 Received By 2 By & <br /> Turn Around Time �' <br /> Signature ] Signature Sig Lure i <br /> ©Same Day Q 48 hrs Printed Name / Printed Name Printed Name <br /> Normal ❑ Rush 0 72 hrs Lft,�'► 4 <br /> ©24 hrs Date j►_ty,, O Time f�� � Date Time 4ate�y fT, , <br /> nictnt.0 Whir l ibnritory riniry t lho—t— Pink PrnjPPVAMO[int Munger nnidrnrod SimplerlOrlgln'tor <br />