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ASSOCIATED LABORAT0 <br /> 806 North Bcrtcnna ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6/900 ■ Fax (714) 538-1209 <br /> 1 <br /> Company—, <br /> Phone �y / C <br /> yc <br /> ,(�fltG� 01 L �.�i.J . A L Job No �+1 � 3 Page of <br /> Protect Manager Fax Analysis Requested Test Instructions&Comments <br /> 6 <br /> fit= au vM �v <br /> Protect Name �!'y � � project# �- <br /> C.� '--- <br /> Site <br /> and Name 12.50 x,114-GON Gv+ 7Z�'C, ,� 7 '0 <br /> Address <br /> IW ©g 'J��57 4 �a J <br /> Sample ID Lab ID Date Time Matrix Container Pres n t <br /> Number/Size <br /> 05-—2-h PV6oi OLO If v04 tow k X /' ! r7NLuca ' Rolw7 j?.t v <br /> 2 -r p'.) —.t o t k��t? "c X X ra-,ca��t avt�/^oo w'% u <br /> l <br /> 4 <br /> MVV -3 2 �,. X x x �C �y wV—'&t)h t�l� <br /> 5 Tb _ M r-r4 }14OL- <br /> 6 2- -'iC K 2 - S 4040L <br /> i3 t '.6'o X X X <br /> 9 r W— ri a5-2.5-�+i 'h0 X X X Y, P <br /> 11 06^Zk-0 00'00 i4?_0 I—VOA— 14 l- x— TA- <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Sampler Relinquished M by i Relinquished by % 2 Relinquished by 3 <br /> G'��� �- <br /> Total Number at Containers Properly Cooled Y/N/NA Sign SignatureSignature <br /> �U�� Cs�r?rY <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Panted Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time too <br /> Date Time Date Time <br /> Turn Around Time Recenred B fi R e 'd By Received By 3 <br /> Signaturep y Si !� / Signature <br /> iNormal <br /> ovFs-t.2.N tl C] Rush ❑Same Day ❑48 hrs Printed Name pogt�d a Printed Name <br /> ❑24 hrs ❑72 hrs �f <br /> Date Time Dale /yew Time. !I Date Time <br /> Distribution White Laboratory Canary Laboratory Pink-Protect/Account Manager Goldenrod Sampler/Onginator - i_7_ S- <br /> / ,� <br />