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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 rj n, Phone r� �}ry /��58Y A L Job No f l� [ ,4 14 <br /> 774Pj FTItom! J J L i Page of <br /> Protect Manager Fax <br /> Jj 6 �Z�— '�� Analysis Requested Test Instructions 8r Comments <br /> Protect Name LL �j Prosect JY 4•- <br /> Site Name <br /> AdaresS r-�C- <br /> �bC�cC cl®� `1152.4 <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 5,0L, > <br /> 2 0 v-,I, k1.60 bA- I+CL- <br /> -z5 $2G©6. ,i t= 0 k:rf,CUZUE <br /> A 1A6 <br /> 7 <br /> 6 I <br /> g <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Reltnquished by /f 1 Relinquished by 2 Relinquished by 3 <br /> Sampler C- Q'r� �t(4 1'I-st <br /> natu �en <br /> Total Number of Containers Properly Cooled Y!N 1 NA SrgSignature ice. 4t(5ill Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed N me 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 Recetyed By 1,� Received By 2 Received By 3 <br /> SrgnaiureO V1,,at4T <br /> L <br /> _%> Signature f Signature <br /> 4Normal ❑ Rush 0 Same Day 048 hrS Printed Name PrintedName' Printed Name <br /> ❑24 hrs 0 72 hrs <br /> Date Time Date,,,1-4 Time Date I ime <br /> Istrih hate ory WEEW LbPink Aeoo ager rod- Orlgi -y / 011111111111 <br />