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ASSOCIATED LMOR,AT®RMS Chain of Custody Record <br /> Lab Job No. <br /> 8o6 North Batavia.Orange,CA 92868LA\ <br /> Phone:(714)771-6900 , Fax:(714)771-9933 Page of <br /> CUSTOMER INFORMATION PROJECT INFORMATION REQUIRED TURN AROUND TIME: Standard: <br /> COMPANY i PROJECT NAME: C' 72 Hours: 48 Hours: 24 Hours: <br /> SEND REPORT T0: NUMBER: <br /> EMAIL: ADDRESS: GJ� <br /> ADDRESS: J� <br /> R Po.#: 0 <br /> PHON FAX: SAMPLED BY: v� <br /> Sample ID Date Time Matrix Container Q <br /> Pres.Number/Size Test Instructions&Comments <br /> z <br /> 3 <br /> 5 C/ <br /> 6 <br /> 7 �^ <br /> 9 <br /> 10 <br /> 11 f <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Total No.of Samples: Method of Shipment: Preservativ 1= Ic 2=HCI 3=HNO3 4=H2SO4 5=NaOH 6 =Other <br /> Relinquished by 1. Received y: 1. Relinquished by 2. Received By: 2. Relinquished by 3. Received By: 3• <br /> Signature: Ig re: Pn Si ur Signature: Signature: <br /> 1. <br /> Prime Name int ane: PPrinte N me: Printed Name: Printed Name: <br /> Time: Date: Time: <br /> Date: me: Dake: Time: D&: Time: Date: Time: Date: <br /> r U ll � <br /> Distribution: White-Laboratory Canary-Laboratory Pink-Project/Account Manager Goldenrod-Sampier/originator <br />