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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 Fax (714) 638-1209 <br /> Company PhoneS 7. , A L Job No `V`'l l Page of <br /> D! I✓ 6j <br /> Protect Manager Analysts Requested Test Instructions&Comments <br /> SUR l�KU6 uf-c* Fax 5-62 y 2�`V 6-w <br /> Protect Name Moll��- S $�,KSite P�v� p tett <br /> and Name �G r-t /, -Vds ZC p :E ca <br /> Address 43 6-'^qContainer <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size <br /> o <br /> 2 o r1TLF� W-00 -Ube 14 CL x <br /> 3 I t4-T-— , to 11 —V ori wet, <br /> 4 114-7- <br /> 5 <br /> VOA 0 Ci L ?C X <br /> 6 -VOA <br /> a � <br /> s <br /> 1G <br /> i1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by 1 Relinquished b Relinquished by 3 <br /> Sample Receipt-To Be Filled 8y Laboratory <br /> Sampler r M' S <br /> Total Number of Containers Properly Cool 1 N/NA Signat Signaturesve ,f Signature <br /> V1 0 -a <br /> Custody Seals YIN/NA Samples In1ac N/NA Primed ams Printed Name Printed Name <br /> 0Pacv <br /> Received in Good Condition Y/N Samples Acce to Dat - Time Date Time Date Time <br /> D P off-z6,-0 <br /> Received By Received By 2 Received By 3 <br /> Turn Around Time Crfl�lft,t4 z (..--- <br /> Signature t Signature Signature <br /> B/Normat ❑ Rush U Same Day 0 48 hrs Printed Name Printed N me p Jo VJ(,� Printed Name <br /> C)24 hrs 072 hrs 1V" <br /> Dat Time DateTime 5o Date Time <br /> ar.n hrfnt— L wh Pmk Acc ager rod Origl _ <br />