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ASSOCIATED LABORATORIES <br /> 806 North,Batcma ■ Orcmcg.e CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 . Fax (714) 538-1209 <br /> Company r r/ ©` Cy Phon �6 z- cY /_ 3 6-P <br /> - f A L Job No `+� Page of <br /> Project Manager fax ! ! r '! <br /> (� �o fzwlzv som 19 (6-6Z) `'�� ��-�j�� Analysis Requested Test Instructions&Comments <br /> Project Name � � Project R <br /> Jul j'qrP�U�C' <br /> Site Name <br /> and <br /> Address <br /> Sample ID Lab ID Date Time Matrix x Pres <br /> Number/Size �- <br /> 3 <br /> J / / <br /> 4 <br /> 5 / <br /> 7 / <br /> 9 <br /> 10 f <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> — V <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by e 1 Relmquii he� 5 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N! A sgnatu r Signature 9() 1 f 6- <br /> Signature <br /> nt N <br /> Custody Seals Y/N/NA Samples inta Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepte Y l N D`a�te � � Time p oo Date Time Date Time <br /> Turn Around Time Receiv ? 4 4 _C?� Received By 2 Received By 3 <br /> Signature V, Signature Si nature <br /> / armal Rush ❑Same Day U48 hrs 0 U� V-�[ CY <br /> ❑ Printed Name Printed Name Printed Name <br /> l� N <br /> ❑24 hrs ❑72 hrs <br /> Date w Time Date Cf Time Date e <br /> -min <br />