Laserfiche WebLink
ry <br /> Z . E ASSOCIATED LABORATAL=, <br /> 806 North Batavia ■ Orcmge, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 - Fax (714) 538- 209 } <br /> Company V--I / O (*t- Ce— Ph e�r v A L Job No Page of <br /> Project Manager F !1 ��U l Fax U l g Analysts Requested Test Instructions&Comments <br /> Project Name V <br /> r Project# r0 <br /> Si <br /> d Name W/-( P kc E-C C e— <br /> Address a7—Q gkTv _ q62-0?— <br /> Sample <br /> 62-0?—Sample ID Lab ID Date Time Matrix NContai Size Pres l f X <br /> 2 w-�# ✓ Of- H <br /> 3 f1tw �� �✓ u'2v CL �Cx- COtLPoulft1� JCA <br /> 4 o l ! f, r 1�I CIA' C�3Tr c�c <br /> flu � t . �c x <br /> 5 dk 1)41 1--- I t w' i+cL- M 7'+,o b 326 <br /> 6 (`'`IN�' ,(tfIto <br /> 3 i d Tc^t�R f�t�i -IoL. <br /> to <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt -To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sam ter <br /> Total Number of Containers L Properly Cooled Y/N/NA Signature Signature Signature <br /> t Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name _ � J Printed Name Printed!Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time Date Time Date Time <br /> Turn Around Time Received By ��1 Received By 2 Received By 3 <br /> i;�� Signature Signature <br /> Norma! Rush <br /> C3 same Day ❑48 hrS p ami Printed Name Printed Name <br /> ❑24 hrs ❑72 hrs <br /> D Time tDat-. T,-- Date Time <br />