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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia • Orange CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 ■ Fox (714) 538-1209 <br /> Company —H f`t i—r ,�r � � Phon ,-,2 `� A L Jots No /`5 v Page � of <br /> Project Manager Fax <br /> r art- v�� �Kv`3Uh14I 5 6 2 'J 2Analysts Requested Test Instructions&Comments <br /> Protect Name Project# y <br /> Site Name 1' �- <br /> andt:�l r�tC►r� C- 6/�� �[. �' :J " rpt / -' U�� VG�GL/ <br /> Address J J <br /> Container i1 n <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size l <br /> s� <br /> tilYL' �4 14 tl— X X X X �rfl�C�L X17 ►'t=&Jri�t t� <br /> 2 <br /> ttil �` r a • 12 Lt%/ 7C X X X <br /> ?< <br /> a <br /> I <br /> I 1 L' - t F a c (! <br /> X x X X r.t'H ftit h i 1-� 0 i,'L6U <br /> 5 t J j X � � M i 17111-r.wL, <br /> 6 �t1,�' — a r,. �'� � X X X Z-- r:-,n4�l-f~(�� <br /> 7 _� <br /> \` /�� F�f I} [fit ' [Jj L T-r+t t C <br /> 13 IV,Tiz- <br /> g <br /> I,2ti� that:}� 4rl 0 1 2–\/CA t--� EL <br /> � <br /> 12 IJ _ <br /> 13 <br /> rr <br /> 14 <br /> 15 \� LiJ <br /> Sample Receipt-To Be Filled By Laboratory <br /> Relinquished by 1 Relinquished by 2 Relinquished by <br /> Sa ter ✓< M L-Z L <br /> Total Number of Containers 2 Property Coo N/NA Signature� Signature ` Signature <br /> Panted Name Printed Name Printed Name <br /> Custody Seals Y/N/NA Samples Intac Y N/NA j <br /> Received in Good Condit, Samples Accept /N atq�!, ,J Time j y Date Time Date Time <br /> Turn Around Time Rece By Received By 2 Received By 3 <br /> Signature Sig ture Signature <br /> ❑Sameay LI D 48 h <br /> �Normal Ll Rush -Printed Name Pnrfted Name Printed Name <br /> ❑24 hrs ❑72 hrs v <br /> Date Time DateC--,<,113101r <br /> 0 Time r Date me <br /> nrcf.h�inn who. i.hnr i— r.— [ahn.xlnry �Rt a..,,.�rra..�„��.,�u�..�.,.,.. r.,i.�......,., c�....,i,..rn............_ -9— r-e 17i '� <br />