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ASSOCIATED r.A.soRATo IEs� <br /> 806 North B rtavia Q Orc nge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 a Fax (714) 538-1209 <br /> /� �q r� Q,C s { , <br /> Company �IKl ©,L W Ph !� 1+_�_ J J A L Job No 9 5o�t\ k' Page of <br /> Project Manager F ra <br /> F �U� V 6 2- J2�r �� Analysts Requested Test Instructions &Comments <br /> Protect Name � Pr lett p <br /> Site Name L-:J o N 1, p A, <br /> and W �� {,(f <br /> Address c T-ou—Tvf4 CA d5w <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> ' �FFLU I I2 I3 04 10-.39 g l p- TF 0�A R #OfIE X At �- <br /> 2 i�l��vF-�!r 12. 13 oi io:za A-('R P-ELL4P- NONE X �c " <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 1G <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished bby£ 1 Relinquished bA ^ x 2 Relinquished by 3 <br /> Sampler r�J <br /> Total Number of Containers Properly Cooled Y/N/NA , Signature Signature Signature <br /> f <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name�B p� ' Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y I N Date 213 04 Time S r Date Time Date Time <br /> Turn Around Time Received ByA:� 1 Received By 2 Received By 3 <br /> Signature Signature �, Signature <br /> ❑Some Day 0 48 hrs Printed Name Printed Name 'r Y Lr Printed Name <br /> Normal ❑ Rush ❑24 hrs 0 72 hrs )`V <br /> Date Time Date Time Date Time <br /> V J, I <br /> Distribution White Laboratory Canary Laboratory Pink ProjecttAccount Manager Goldenrod SamplerlOriginator <br />