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ASSOCIATED LABORATORIES LJ <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 • Fax (714) 538-1209 <br /> Company.' I 01 <br /> L &CPhon �r 2 1ga1Lr3 t A L Job No t3 g s F-0 Page of <br /> Protect Manager �U�C�` I�r f Fax C6,6_ <br /> g2�_Y5Jt� alysts Requested Test Instructions 8r Comments <br /> Protect Name v <br /> Site Name <br /> and <br /> Address <br /> !?672-09 <br /> ,� R <br /> � k � <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size p. <br /> 1 0 09U:7-,-f 0-A--01f MAO 4 p —,�� 1 svX. ! IC- c.o�Fz r-kmFt a� <br /> 2 d V 7'ut ,Do I 1 3 ---vO4 tfc& X $2(;o d3 "r- oo-mcT?tt <br /> 3 <br /> 4 <br /> 5 r1-4 u;-F �2.m.� �f r V00,+ <br /> 6 <br /> 7 <br /> 9 <br /> 10 <br /> i1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 �Z=l I 1--A H+ I <br /> Sample Receipt-To Be Filled By Laboratory Relinquished byt M 1 Re{tn��qu�ls;,�d yy � �2 Relinquished by 3 <br /> Sampler <br /> !� f l {ip F� <br /> Total Number of Containers Properly Coot YN!NA Signa Signature }F.�� ��f> Signature <br /> Custody Seals Y l N/NA Samples lnta t Y N/NA Prin � W�w Printed Name Printed Name <br /> Dae TimerrDate Time Date <br /> Time <br /> Received in Good Condition Y/N Samples AccY/ D - ;.0 <br /> Turn Around Time Receiva22�� M 1 Received By 2 Received By 3 <br /> , <br /> Signature & Signature ignature <br /> (N�Normal ❑ Rush 0 Same Day ❑48 hrs Printed Name Printed Na Printed Name <br /> ❑24 hrs ©72 hrs <br /> Dat Time Hate o 3 1 Time }�, Dat g 0 <br /> Time L/ <br /> Distribution While-laboratory Canary Laboratory Pink Project/Account Manager Goldenrod SamplerlOnglnator '�I 7 <br />