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ASSOCIATED LABORATORIES LAk <br /> 806 North Batavia ■ Orange, CA 92,668 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company 77tnK%[', © t Phone 56,–J`62/- 56W <br /> 6 L `62/` 5 6 / ) Baa (n <br /> 0'! A L Job No _.�.t�+ Page—i—of <br /> Project Manager Fax <br /> r �UP- 1)M}} 562 X121--;Z w Analysis Requested Test Instructions&Comments <br /> Project Name ,,I� W �y'�Project p � �Site <br /> Name <br /> and > ` �L Ir' i� N, <br /> Address _ <br /> tr <br /> Sample ID Lab ID Date Time Matrix Container Pres a Q <br /> Number/Size <br /> ' 0U l.e-r k96 n3-o4 f42-o I-- I L i4z3o }c C��ir---xPkl f-LFPVL PILI <br /> z <br /> Ovi U.,-r 150. 3-v o) 4CL- <br /> �.� <br /> s (4o 13-Gu 1—6-00AI& t4o�IA <br /> 4 1147-- o 4— vof� €+tL x )< <br /> I to —2 LV IO 4 -110 L+CL � X <br /> 6 l�.w—fid <br /> )-610 4 —vpA 14q. <br /> 4 VaA- f+a <br /> 8 <br /> s � <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished 6y ! G 1 Relinquished Relingwsfied 6y 3 <br /> Sample Receipt-To Be Filled By Laboratory sam ler � 7r f� <br /> Total Number of Containers Properly Cool Y/N/NA Signal Signature Srgnature <br /> 14 Custody Seals Y I N/NA Samples Int Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samptes Accept(—Y,/ Date Time Date Time Date Time <br /> Turn Around Time Received�Byy 1 Received By 2 Received BByy� a <br /> Signature Ll <br /> 9� Signature ignature <br /> - <br /> J <br /> El Normal Rush U Same Day U 48 hirs Printed Name <br /> m Printed NamePrinted Name <br /> . U 24 hrs U 72 hrs �o��° <br /> Date Time Date Time Date « ,71,& <br /> tttputLit.-L1111W C link cco er Sa ginat <br />