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ASSOCIATED LABORATORIES <br /> 2 806 North Bat=a ■ Orange, CA 92868 <br /> Chain of Custody RecordPh one (714) 771-6900 m Fax (7 4) 538-1209 <br /> Company �-r/17 , / �! Phone ry� Dn 3�Q J <br /> 1 l't K.i fT 76 J L U 7 A L Jab No Page of <br /> Project Manager -+ Fax Analysis Requested Test Instructions& Comments <br /> Project Name liQ (J Protect a } 2 0 <br /> Site Name <br /> and P4C ,�: C4 AVE l L- <br /> ''ff <br /> Address �37 _GM711 M 15 r)4 ,</ - � r <br /> J . <br /> Sample!D Lab ID Date Time Matrix Container Pres <br /> Number/Size �C <br /> 05 1I oy 13'30 4GL. Sc3 PaVig&b FoP <br /> 2 Mtiv - I3'�o <br /> XXX v UFWM�-A ci-111P004 43 <br /> (A &ASoo'd <br /> XIXK FPA- MF7Hoq 8260 <br /> w_ /l� �aI XXXI z M4 l4 I, <br /> k, MTbG <br /> g P 9041 13-.% 2V'AVs <br /> 10 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by i Relinquished by 2 Relinquished by 3 <br /> Sam ler <br /> Total Number of Containers z-7 Properly Cooled Y!N 1 NA Qu signature Signature P Signature <br /> TV Printed Nameh Printed Name Printed Name <br /> Custody Seals Y/N/NA 00 Samples Intact Y/N/NA �� �iQ�f 1� <br /> Received in Goad Condition Y!N �� Samples Accepted Y/N P Date©� rr tl Time Date Time Date Time I <br /> J Recelved IByr 1 Received By 2 Received By 3 <br /> Turn Around Time <br /> Signature Signature Signature <br /> ❑Same Day ❑48 hrs Printed Name +e Printed NamePrinted Name <br /> Normal ❑ Rush ❑24 hrs Ll72 hrs �` 4,)15 <br /> Date Time Date :5 ZZ.41 Time Date Time <br /> Risinbuhon While t ihoritory Cinvy I-rhnrilnn/ Pink PrnlertlArrnunt 6A in+qrr rnir r—rl S mglrr/flrir7ln I�r <br />