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i ASSOCIATED LABORATORIES LAO\ <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 Fox (714) 538-1209 <br /> Company 79$216Tt <br /> �f n �] <br /> j P " / --• �� A L Job No " Page Qf <br /> Protect ManagerAnalysts Requested Test Instructions & Comments <br /> Protect Name V � 1 W _ J Pr eat p 'y � <br /> Site Name <br /> and / . ! 1, r J 1 W �✓ <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres Y <br /> Number/Size <br /> 3 M � x XC � <br /> XXX COHPOO�4Ds V :5-ab <br /> 1!4 a. cqwu'ds <br /> I�tU3 '- 6. X XCPf-�1�T1�f00 �z�� <br /> G �f l6{'; X !' <br /> X*1 XX <br /> 8 71� 'i- <br /> g � 6710 <br /> � x T�'"t I�u7�OL <br /> 11 <br /> 12 4c) <br /> 13 <br /> 14 <br />� 15 <br /> Sample Receipt-To Be Filled By Lab tary Relinquished beli <br /> y� 4 RnquieRelinquished by 3 <br /> shd <br /> Sam ler <br /> Total Number of Containers Properly CoolY/N NA Signature Signature Signature <br /> Custody Seals Y N/ A Samples Intdc Y/N/ A Printed Names ee Printed Name Printed Name <br /> Received in Good Cvnditio Yi N Samples Acc ted Y/N Cato© 'A�Time / pate Time Date Time <br /> Turn Around Time Rec■Ivgjf_By�t� QQr Received By 2 Received By 3 <br /> Signature Signature Signature <br /> &/Normal Ll Rush ©same Day ❑ hrs Printed Name Printed Name Printed Nam <br /> L)24 his ❑7 72 2 hrs <br /> ! 'Date Time Date TimeDate Time <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod-SamplerlOriginator �� `'F f �/ �� <br />