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ASSOCIATED LABORATORIES <br /> Ak <br /> 805 North Batavia * Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 � <br /> i <br /> Company �fT I✓ t L C�j'. Pho '� Z — '7�1l A L Job No '✓ Page aT <br /> Project Manager ,Fax <br /> I � Z , —rj`, j Analysis Requested Test Instructions&Comments <br /> I Project Name Prolectf / y <br /> I 2— <br /> Site Name ` �W �7 t 1 0607-CA Jai 2- <br /> and Z�17 �Y . L!L 1 / T <br /> u <br /> Address 5 LJ i .-� <br /> R c� t <br /> Sample ID Lab ID Date Time Matrix Container pins ,, l •} <br /> Number/Size �� t <br /> ,cu <br /> 4- V ark 14 CG Kx y jn <br /> f <br /> 4 "'VM <br /> � 't� I �G 7C X �!� {•' � � a Its �. <br /> I MW -4 <br /> ii Twv <br /> 16 Kau -L- <br /> 1(,;V ! <br /> - � x K x 2--LTi-rrias <br /> J <br /> 'K X <br /> fo <br /> 11-00..A <br /> 311 U J <br /> Ill <br /> 13 if <br /> f <br /> Ito <br /> T'5 i <br /> I� Sample Receipt-To Be Filled By Laboratory ! 5aRelinquished M C'_ 1 Reiinqujshad b>� <, 0, 2 Rei,nyurened lav s <br /> I�Total Number of Containers Properly Coolet 1 /N/NA Signal � Signature Signature - <br /> Custody Seals Y/N/ A Samples Intac(Y/N/NA JI Printed Name Pnnted Name Pnnted Name <br /> !i gv-tprvt <br /> Received in Good Condit Y Samples Accept Y/N Date Time � Date Time Date Time <br /> i. <br /> Turn Around Time I I Received By- f Recaired fW 2 Received By 9 <br /> I Signature Signature 1 J Signature <br /> �10/Normal ❑ Rush Ll Same Day D 72 hrs Printed Name Printed N e) v�V Printed Name <br /> 0 24 has ❑72 has <br /> L.t* <br /> Time Dale Time Date Time <br /> IIIc ' r I�stihution WN oratory Canary-Laboratory Pink Prol0WAccoumManager Qalderuod Sampler/O �� // ,/�fir' <br /> I ll LJ <br />