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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 it Fax (714) 538-1209 <br /> y77fi�f l <br /> Company Phone -6 G7�J^ `�� A At. Job No �� r� Page of <br /> p � � C C9 � g .J i ✓1;�f <br /> Protect Manager Analysis Requested Test Instructions &Comments <br /> F�-jr � �tl� i$-/�tJ��✓�!� Fax �.� p�2�� yr�^� Y <br /> Project Name n p�1�P+otect`# 1*2— fi'� <br /> Site Name y/� n�+,` ti � <br /> and �J b 4 )r�I,-'!�I/a L� Lyfr I_ j <br /> Address <br /> k��- <br /> 1 <br /> = � rSample IQ Lab ID Date Tlme Ma#rix ContainerpresCL <br /> Number/Size <br /> 0 )O,00 1420 —1 1 u1 X <br /> 2 to "00 V014 NU- <br /> 4 T N 1 r/ 10 ,1,0 if °- V 0 14 a, <br /> 5 ` ^. -2 4 :10 VOA- 4 U, <br /> 5 t\AW'- 1r to:'r Valk I+C{. X1 I <br /> iKW1'r n! - voff- t.4t), x <br /> a ' <br /> g k I <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished b 1 Relmyyu,�is�hed by Relinquished by 3 <br /> Sample Receipt-To Be pilled By Laboratory Sampler F�l e-- <br /> Sig <br /> � Cs'��8 <br /> Pro ra Coale Y N!NA Sign Signature p Signature <br /> Total Number of Containers pe Y C;ffZQ�4T <br /> Samples lntac Y/N/NA Printed Name Printed Name Printed Name <br /> Sam <br /> Custody Sealy I N!NA p <br /> D <br /> Received in Good Conditi Y N Samples Accepte ©'.�/ Time J It-, <br /> g-w Date Time Date Time <br /> Turn Around Time Recervgd aY '*t4 a� Racerved By 2 Received By <br /> 3 <br /> Signatu�rree� Signature 'Signature <br /> OUa G4V <br /> Normal ❑ RuSh ❑Same Day ❑48 hrs Printed Name Printed Na a Pnnted Name <br /> ❑24 hrs ❑72 hrs 'W <br /> D Time Date Time f o Dale Tome <br /> a <br /> P,r, ct/Ae nage�nrod�dorn ' _ <br />