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A kASSOCIATED LABORATORIES Date 611�/11 Page Of-J— <br /> 906 North Batavia-Orange,California 92868 1 <br /> Phone. (714) 771-6900-Fax. (714) 538-1209 A <br /> CHAIN OF CUSTODY RECORD Assigned LR# <br /> PROJECT IDENTIFICATION/LOCATION: SAMPLE TURNAROUND TIME: <br /> CLIENT: Requested Turnaround Time(CIRCLE ONE)* <br /> Priority Charges Apply to Rush Turn Around Times <br /> ADDRESS-.. RUSH: Same Day 24 Hr 48 Hr 72 Fir <br /> PURCHASE ORDER#: STANDARD: Standard TAT**(S to 10 Working Days) <br /> 0 ri'!i r A, c, Other <br /> report to be sent to? Yes No <br /> Is this the �s the&,I is SAMPLER:(Print AND Sign) <br /> Availability of Same Day/24/48/72 Hr TAT Varies Based Upon <br /> If"No"list mailing address in"Special Instructions"section at the Test Method Requirements, <br /> bottom of this Chain of Custody. "Standard TAT Varies According to Analyses. <br /> SAMPLE CONDITION INFO-FOR LAD USE ONLY: <br /> NTACT PERSON: Qw� PHONE#: ( - ') <br /> \j Samples Intact- Yes No <br /> SA, Sample Seals Intact: Yes No NIA. <br /> SAMPLED BY(Circle One): Client Assoc.Lab Personnel FAX#: L,3 .......... Cooler Seals Intact: Yes No <br /> N/A <br /> Sample TD Sample or Location Description Date Time Matrix(See #of Preservatives Test Required <br /> Codes Below) Containers <br /> Litt <br /> T(oj C 2— fle-1 —AZ OW-S <br /> ............ <br /> MATRIX: GW=Ground Water DW=Drinking Water WW=Waste Water SW=Storm Water S=Solid/Soil A=Air L=Liquid F=Food (Use the codes shown here to identify the matrix above) <br /> Relinquished by:(Print AND Sign)*** Received By:(Print ANT.)Sign) Date Time:jj:.30 Sp I I <br /> ecia �pstructions: <br /> /< <br /> Relinquished by:(Print AND Sign)* Rrf :> <br /> y:(Print AND Sign Date/Time: <br /> 11 /7t:c <br /> q A <br /> Relinquished by: Received by Lab for Analysis: Daterl'ime- <br /> (Print ANT)Sign) '5 <br /> ***By signing this Chain of Custody you 4-1 co DISTRIBUTION: <br /> I....... -(41 A��I <br /> are authorizing the analyses shown above, (Print XKD Sig White with report. Yellow to AL. Pink to Client's Courier. <br /> L <br />