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ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 x Fax (714)538-1209 <br /> CompanY^� �j Phone <br /> f r"► 1C-1 (! o t L r 5'62 2_ --3158 A L Job No Page of <br /> Prosect Manager Fax <br /> Fr(' — 5-U 'ev�v"* S`/,Z 2 — j,(,t� Analysis Requested Test Instructions&Comments <br /> Project Name NJ I Project <br /> /t'lON774-t- W*-Frc l2 1661'2P1 f 7` <br /> Site Name (` <br /> and i <br /> Address <br /> Sample ID Lab ID Date Time Manx Container!N <br /> umber/Size Pres <br /> 2 mv � <br /> r4G4 <br /> 3 <br /> I'ti T. -- VD4 vtu 'je x <br /> a <br /> e <br /> s <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> I <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by�. . I• 1 Relingv�sh�eb� 5 Relinquished by 3 <br /> Total Number of Containers Properly Cool,,/N/NA Signalur �/j Signaturet/�ru�iz� !�I✓•�/¢ri c— Signature <br /> Custody Seals Y/N/NA Samples Int>`�rt_Y/N/NA Prm �- �� Printed Name Printed Name <br /> ame <br /> Received in Good Condition Y/N Samples Accepted'T/N D} Time Date Time Date Time <br /> �. Turn Around Time Rec ived Bviv. Tit Received By 2 Received By 3 <br /> Signature Signaturef ___t� <br /> Normal L) Rush Ll <br /> U/ <br /> D Same Day 48 hrs Printed Name(a VAJagiQ Printed N e / Printed Name <br /> L� es X4,1 <br /> (3 24 hrs D72hrs l <br /> Date Time Date Time Date im i <br /> • j - 2 Z' r o -Z ztJ <br /> Distribution White laboratory Canary Laboratory Pini Project/Account Manager Goldenrod Sampler/Originator <br />