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ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orange CA 92868 <br /> Phone (7I4) 771-6900 Fax (7�I4} 538-1209 <br /> Chain of Custody Record <br /> Company / f ! r'--� �L, O )-6 y 11— �t 1� A L Job No t � Page of <br /> Project Manager r(� r r Requested Test Instructions&Comments <br /> ILt Fax '(-t� --Analysis <br /> Protect Name �r/-�-,,�+7� ��}�--��''C Profec M <br /> Site NameG <br /> and <br /> Address15 <br /> Sample ID Lab ID Date Time Matrix Container Pres + <br /> Number/Size <br /> ' f � <br /> 2 rr c�.i� i.r/1 - rj-J•a- � � '1 L) f�lo� ��t7�+�t b3 lvt7 ' x x <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> a <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by1 RehnRelinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory sa ler• r gir y SA fZT� <br /> Cooled Y 1 N/NA Signatur Signature } �r Signature <br /> Total Number of Containers Property �-C�"� V{, &!a P%` <br /> Custody Seals Y 1 N 1 NA Samples Intact Y 1 N 1 NA Pnn cNAe ff".15 Panted Name Printed Name <br /> L I i <br /> Date <br /> ^ "`Time Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted Y/N e -��^c j 1 <br /> Turn Around Time <br /> Received Lrz ti� � Re g L�'C llx Received fay 3 <br /> Signature r-► J C� Sig = CJ Signature <br /> ©Same Da ❑48 hrs ' <br /> Normal Ll Rush y Panted Name Pnn QI � Panted Name <br /> ❑24 hrs O 72 hrs f <br /> Dat Time Date Time y rl Date Time <br /> .. _ __ �.._.... i...,...n... c-i, P. i—VBrrmmt Manan'r Goldenrod Samol /Ominator <br />