Laserfiche WebLink
ASSOCIATED LAl3UKHH4um"""806 North Batavia ■ Orange, CA 92868 <br /> Chain* Custody Record <br /> Phone (714) 771-6900 • Fax (7I4) 538-76,M9 <br /> 41 <br /> Company i v/ ` CZ Phone 5� Z J` � A L Job No � � pa9e�of <br /> �� f J(� <br /> Protect Manager 1 F 36 G 2-t Analysts Requested Test Instructions&Comments <br /> Protect Name Project �1 <br /> Site Name !l <br /> and Lo llso&I W#L1 <br /> Address c Ce-7-9 CA <br /> . 352�O - <br /> Sample ID J Lab ID Date Time Matrix Container pros <br /> Number/Se <br /> 2 ir�FWits o4-1f-1K 1) 4o t4(9 -A <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> i <br /> 15 ii <br /> Sample Receipt-To Be Filled By Laboratory Samplulshed by 1 Reirnquiser ed bit � 2 Relinquished by 3 <br /> Sam l �4 W ' <br /> 1g Signature Signature <br /> Total Number of Containers Property Cooled Y/N/NA 5 <br /> ;;J a iLJ".1 <br /> Panted <br /> Custody Seals Y 1 N 1 NA Samples Intact Y/N 1 NA me Panted Name Panted Name <br /> t� <br /> Date Time Date Time <br /> Received In Good Condition Y/N Samples Accepted Y/N n Time iii <br /> Turn Around Time Received e 1 RecevalBy 21 Received By 3 <br /> Signature i I r " Signature <br /> Normal ❑ Rush 0 Same Day hrs Printed Name Int Name Panted Name <br /> ❑24 hrs 0 72 hrs <br /> Date Time Date " Tlme t Date Time <br /> r <br /> Oistributwn White Laboratory Canary Laboratory Pink ProtecuAccount Manager Goldenrod Sampter/Onginator <br />