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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company THO 0.�, D 1�- Cly Pho2 7q�6� �J�O� Al,A 1 Job No �5 Page of <br /> Protect Manager FaxAnalysis Requested Test Instructions &Comments <br /> Protect Name <br /> Protect t <br /> Lu*qr,-R ( �' <br /> Site Name <br /> and *60— Akd�--e QY16 <br /> Address 67 <br /> MD04 C)4- V5'201 <br /> Sample ID Lab ID Date Time Matrix Container Pres � <br /> Number/Size <br /> //:vo r o 4 VL-)A q(! x K )c <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> B <br /> 9 <br /> 16 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Saim lershed C 1 Reltnqur ed%, Relinquished by 3 <br /> Total Number of Containers Properly Cooi Y/N/NA Signa Signature 0 16"047j- Signature <br /> Custody Seats Y/N/NA Samples Inta Y/N/NA Prin Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepte Y t N Dat�� ���/_ Time�j ��i3 _ Date Time Date Time <br /> Turn Around Time Rece�d BLyhvr /�131c �p Reserved 8y 2 Received 6y 3 <br /> Signature�da��1 r �l�� �`� Signature ,� L� Signature <br /> 6 Normal ❑ Rush 0 Same Day ❑48 hirs Printed Name r� Printed NaTbe Printed Name <br /> ❑24 hrs L1 72 hrs <br /> Date Time Date Time fit, Date imc <br /> _sWbuf ite-�ry clmlabor�ark �ccou�er �d S Mi igma _ <br />