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ASSOCIATED LABORATORIES LA <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-I209 <br /> Company 0:71P on <br /> : Phone Z r�lr. / A L Job No �LJPage of <br /> Or 4 <br /> Project Manager S� �UM�` Fax c�2(--`�rj (� Analysis Requested Test Instructions&Comments <br /> i <br /> Project Name ProjectN-rC60*,iy- a 6 If <br /> Cho <br /> Site Name `y 7 fp C4 G F rI � , f /C � )it <br /> and Q <br /> Address <br /> 1 9-f - Q� � C a <br /> ` <br /> ll <br /> eY'1 h y <br /> Container I <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size <br /> C2 �p;'a <br /> ' <br /> MW _ I <br /> 2 M vii— fy D ?� "P, Co KIP©v t t bs vs ► <br /> 3 M� �2'•� x )C EN C4 G-,+S0 ire A Z <br /> > � g X3•.1~ 7C _ �,Tf-� ot. <br /> MW <br /> ttt4(k��."I <br /> 9 W ,4ht -�yV"V�iOofMIS)lr�. µms� <br /> t <br /> 0 vv 40µ <br /> 11 <br /> 521 <br /> � <br /> - <br /> 13 <br /> 14 <br /> 15 <br /> Rehngwsh y 1 Relm uis ed b Relinquished by 3 <br /> Sample.Receipt-To Be Filled By Laboratory Sampler' tm c <br /> Signatur Signature Signature <br /> Total Number of Containers l l Properly Cool Y/ /NA 0 V `Z� <br /> Printed Name Printed Name Printed Name <br /> Custody Seals Y/N/NA Samples Int Y I NA �,� ,��� <br /> Date Time Date Time Date Time <br /> Received m Goad Condition Y/N Samples Accept Y O Z,"t 2.�J Q��r d`j <br /> Received By 1 Received By 2 Received By 9 <br /> Turn Around Time �p�1 S 1 Y?+'C� <br /> i Signature1 Signature <br /> V R2 <br /> � O e-�t 1 <br /> ❑Same Day ❑48 hrs Printed Name Printed N Printed Name <br /> �Normal <br /> 0 Rush ❑S, hrs ❑72 hrs <br /> . Dat Time date Time to DateTime <br /> ue .A Lnh VWPink Acco ger Ed-S ngin <br />