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ASSOCIATED LABORATORIES LAk <br /> 806 North Bartavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Phone �' <br /> Company 7- Q F_ �! L C-66 Z 12_1f "�5�7 A L Job No Page of <br /> Project Manager � � U M-kt-- Fax *z q 24 Analysts Requested Test Instructions 8r Comments <br /> Project Name d{ -vJ w Protect 3 1 O1 <br /> Site Name � 4 � P*ar--i� Lo � N <br /> and opo <br /> Address S C4Z'T-&14 <br /> Container <br /> Sample ID Lab ID Date Time Matrix ember/Size Pres Q <br /> 1 r t•f-! 2-Dfi�Jt-t ra Ll-Vof(- 1f m ) k <br /> 3 <br /> A/4 <br /> 5 <br /> 6 <br /> 7 <br /> B <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished bYF- .m <br /> 1 Relingyx sh-e by 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler F .m •� C�'t7 F-->+`F 8577"7 <br /> SPirginSignature <br /> Signature <br /> Total Number of Containers �I Properly Cool NA tm - Vrft_}tiC'1P-e- <br /> ted <br /> Name Printed Name Printed Name <br /> Custody Seals Y/N/NA Samples Int Y/N/NA �i:r�— .� <br /> Date Time f Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted N �'I'D�ar? A <br /> Recsy M Received By 2 Received 8 3 <br /> Turn Around Time exed <br /> Signature G- Signature ignature <br /> 0 u G-:Rfi <br /> dor a� RUSK <br /> L)Same Day C348 hrs Printed Name Printed Name Panted Name <br /> ❑24 hrs ©72 hrs <br /> DIE Time Date 1Z Time D7 tom Time <br /> I � � <br /> 93rn4 P—H/Arcnunt Manager Goldenrod sampler/Originator <br />