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ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orcmge, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> �3g7�1 <br /> Company NPho01 L Fan 6 92 r3 C A L Job No Page of <br /> Protect Manager SuR 'USU n H Pax 5.6 <br /> „) 12-1 <br /> �} _ kv Analysis Requested Test instructions&Comments <br /> Project Name 1 . , 6 !�- I"G+JS� Project p L i L f <br /> / V- <br /> Site Name W ` IhLr2 � <br /> and 'MO [ ca <br /> cd <br /> Address :STOClTDt4C-!4 6640 <br /> 9 <br /> 1�GK <br /> Sample ID Lab ID Date Time Matnx Container!NFires Z <br /> Number/Size � � <br /> ' 114T;-/f 41-02-q4 12'10 420 1f Volk 14 Cl- �C <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> B � <br /> 7 <br /> 8 <br /> g <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Salm gushed by n .� 1 Reiln wshe Relinquished by 3 <br /> Total Number of Containers , Properly Cool Y 1 N/NA Signature s�� Signatur©V JF”1G� Signature <br /> Custody Seals Y/N 1 NA Samples Intat Y I N I NA Printed Nam a w Printed Name 1 Printed Name <br /> Received in Good Condition Y!N Samples Accept Y!N Dat 1-0 2--O� Time ill-'.( 0,2 Date Time Date Time <br /> Turn Around Time ReMlr7- 1 Received By 2 Receive 3 <br /> Signature Vt �lipt Signature Signature <br /> Iy NOC 1 LJRush ElSame Day L)48 hrs Printed Name Printed Name Printed Name <br /> L)24 hrs El72 hrs y <br /> Da Time Date r Time (,� Dpij Time <br /> 7 <br /> whn.. rah,r.i C..r.ar„ 1 ah.rntnm Pink Proiect/Account Maneoer Goldenrod Sampler/Originator <br />