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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia a Or=ge, CA 92868 <br /> Chain of Custody Record Phone (724) 772-6900 Fax (714) 538-1209 <br /> Company` t e� Phone 2 1— 5 C'q <br /> 11183�� <br /> y q �( a P-t 7 A L Job No Page of <br /> Protect Manager ` U /fi 1 MLlJ Fax `j 6 C� 4.!"" '7- ", <br /> "I Analysts Requested Test Instructions&Comments <br /> Protect Namet Protect 4 9 r� <br /> Lt_ U-1 fl <br /> Site Name �7 9 <br /> and L�7- f-/�c(!—I C- IVF <br /> Address <br /> 1 <br /> Sample ID Lab ID Date Time Matrix Container Pres 4 <br /> Number/Size . �4 <br /> t Q?V i G <br /> 2 9 k%'i P�..r al.'00 1l vA G� -- <br /> A 1`P I . - �.'40 -V0� 14CI. <br /> qT —2 —Vah- 14 CL X <br /> 6 M w-A4 o —Ung qct- <br /> ' ' t gwF,F —Voll t -CL <br /> 8 <br /> 9 <br /> 10 <br /> tt <br /> i 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory SRelinquished b M t Relmauish� y� $ 7J Relinquished by 3 <br /> am ler ( � <br /> Total Number of Containers Property Cool Y/N/NA -5i-gnat Signature il h 2,4 iC W Signature <br /> Custody Seals Y 1 N/NA Samples Iniac N/NA PrintedPrintedNan � DPF- w Pnnted Name Printed Name <br /> Y/ <br /> Received in Good Condition Y/N Samples AccepteY/N Dat f 1. Time f,/`3 v Date Time Date Time <br /> Turn Around Time Re U�rvei d�B � 4TAT #c T Received By .. Reserved B3 <br /> Signature r7 Signature Signature <br /> 0 U 0?, 0= <br /> 8 Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed!Name P k.VW c--,,—./ Printed Name <br /> 024hrs U7 hrs <br /> D Time Date j <br /> 2V Time Date Time <br /> _ Distr XW toryVW-La= Pio=et/AcM11rta9e1Wnrod�r/0,, i <br />