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ASSOCIATED LAsORATo <br /> C I�a i n �;L1Stody Record ' _ 806 North Bartcma • Orange, CA 9286 <br /> S <br /> t Phone (714) 77I-6900 Fox (7I4)538-I209 A <br /> Compan <br /> Project MY / K/F Phone 2- 4 `a 6—? A L Job No I <br /> 1� Manager Fax Page of f I <br /> Project Name j� �j., �.( 62 9 u ^15 '� Analysis Requested Test Instructions&Comments <br /> Site Name "' ``p 'i+ r `A �f erect!I J - L� <br /> and 2 + - {�! L�{'! �J /( <br /> Address <br /> "al-3C44 O Y4 Ili-210 <br /> Sample ID Lab ID DateTime Matrix Container <br /> Number/Size Pres <br /> No�k x <br /> a <br /> S , I� <br /> I I I <br /> 10 <br /> is a� <br /> 31 If I' I� <br /> ZH <br /> r II <br /> 12 17 <br /> I � <br /> I� <br /> to �� I <br /> I ' <br /> Sample Receipt-To Be Filled By Laboratory Rak-n"qu by ftett�,�„f>:ned /� Z pel Waned <br /> by <br /> Total Number of Containers 4/ Property Cooled Y/N J SSiignat�r _• !� ,, �'d 3 I! <br /> i I Signature Signature <br /> Custody Seals Y/N/NA Samples Intact /NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y J N Samples Accept NTimee i Date Time Date Tune <br /> Da i <br /> -0rj 'Df; It oD <br /> Turn Around Time Remllved sy� Raceitrod Byr 2. Received Or 3 <br /> Signature 4 Signature Signature Iryry <br /> ©Same Day L)48 hrs II <br /> NOf�'13� ❑ Rusht'nnted Name Printed NAme <br /> 0 T2 hrs Printed Name <br /> 0 24 hrs <br /> o nJb �'�! i <br /> Date Time Date Time A JC Date Time <br /> Distribution White Laboratory Canary Latwralory Puck Project/Accamt tlAanaper Goldenrod Samptarlonga>tiM <br />