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L <br /> ASSOCLATED LABORATOMS A\ Chain of Custody Record <br /> 806 North Batavia-Orange,CA 92868 Lab Job No. <br /> 1 of <br /> Phone.,(714)771-6900 it Fax-(714)771-9933Page <br /> CUSTOMER INFORMATION PROJECT INFORMATION REQUIRED TURN AROUND TIME: Standard: F— <br /> COMPANY PROJECT NAME. 72 Hours: 48 Hours: 24 Hours: <br /> SEND REPORT TO: Num"F;R: <br /> EMAIL: ADDRESS: <br /> ADDRESS: <br /> IN "LOYv Llj <br /> P.O.#; ffD Ct-1 0 <br /> PHON : SAMPLED BY: <br /> Sample ID Date Time Matrix Container Pres. <br /> Number/Size Test instructions&-Comments <br /> IS <br /> 3 <br /> 6 <br /> 7 1�7 <br /> 10 <br /> ill <br /> 12 <br /> 13 <br /> 14 <br /> 15! <br /> Total No.of Samples: ZMethod of Shipment: Preservatiiii 1= 1cp, 2=NCI 3=HNO3 4=FZSO4 5=NaOH 6 =Other, <br /> Relinquished by 1. Received y: 1. Relinquished by AZ 2. Received By: 2. Relinquished by 3. Received By, 3. <br /> Received <br /> .- 7. 1 Signature: Signature: <br /> Signature: 19 re. Sig Si ure <br /> Prima int -ame: Nime: Printed Name: Printed Name: <br /> ,�Q Name; V� Pr, I <br /> =IVX ) 4-LtM <br /> e. T"! Date: <br /> . I <br /> Do <br /> --- 11 11 M <br /> Date: k �Jrima: Dake: Time: DIe� Time: Tme:, Time: Time: <br /> 11 <br /> Distribution: White-Laboratory Canary-Laboratory Pink-Project/Account manager Goldenrod-Sompler/Originstor <br />