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. ASSOCIATED LABORATORIES <br /> 806 North Batavoa ■ Orange CA 92868 LJ <br /> Chain of Custody Record Phone (7I4) 771-6900 Fax (714) 538 1209 <br /> Company <br /> -7W2Fr 01 L— C.1r A L Job No Page of <br /> Project Manager w Analysis Requested Test Instructions & Com <br /> ments <br /> Protect Name y ,y � 5 � r�L J�CY� Protect M <br /> Site Name A JVD <br /> and /� .�7r/ /`F Lid' ► r7 w!L`66)w VtJ/'1 I 1_ `1 t <br /> Address CIA ` -,J6-to-5- <br /> 7 C'g„ p r l <br /> Sample ID Lab ID Date - .Time� Matrix Container Pres �� <br /> Number/Size X F <br /> MW 2+ 112,20/ 10 "'glkf 12 /` -V AR, ifk)Ne- -74 <br /> TRS �J� d �r� - X X <br /> 3 <br /> 4 , `3 ,� 5v x KX <br /> ra w wo5 <br /> 6 <br /> X X I X <br /> 9 rt'Ps6T��t 12' 16 X <br /> i,01 I <br /> 12 <br /> 13 <br /> 14 <br /> i <br /> 15 " <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 : <br /> Sampler I <br /> Total Number of Containers Property Cooled Y/N NA Signature Signature Signature <br /> Custody Seals Y/N NA Samples In t Y NPrinted Name Printed Name Printed Name <br /> A <br /> �- <br /> Received In Good Condo 7YN Samples Accept Y! D C9 Time A+O i! , Date Time Date Time <br /> Turn Around Time Reid By 1 Received By 2 Received By 3 f <br /> �,/ t e Signature Signature <br /> 19 Normal Rush U Same Day ❑48 hrs p a e Printed Name Printed Name <br /> ❑24 hrs ❑72 hrs <br /> t AA T Date Time Date Time <br /> E <br /> "'Inhif inn White I ihnratnm r aniry t ihwatnr Pinli PrnieNlArrrnmt M-innnnr GniAnn*^A " mnlnrPAriol-lin , <br />