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ASSOCIATED LABORATo E� <br /> LAk <br /> 806 North Batavia • Orange, CA 92868 <br /> Ll Phone (714) 771-6900 . Fax (714) 538-1209 <br /> Cham of Custody Record <br /> Company�� /+� O W Pho e�/Z Qz /_35�o AL Job No Page of <br /> Project Manager / Fez O ✓✓ 4 Analysis Requested Test Instructions&Comments <br /> t'01- <br /> Project Name V V, Q of M ZA �I`n /� y Project ff , J J Q <br /> Site Name <br /> and !'l� (b 12 5- ) r Zvi--/ r J <br /> Address GST l CA • P { <br /> Sample ID Lab ID Date Time Matrix Container Fires <br /> Number/Size C <br /> 1N 06 12 04 10.00 unoIQ 1(F-T) R q0 CO�i t R.'t-f" <br /> 2 <br /> 00TW, o oA A, lxxxl I +�tvA ol2.I� r� <br /> 3 <br /> 1B q )I.00 - 1Cr�U • <br /> a � <br /> LV = <br /> s 00 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by 1 Relinquished by 2- Relmqutshed by 3 <br /> Sample Receipt-To Be Filled By Laboratory <br /> Sampler., <br /> Total Number of Containers Properly Cooled Y/N/NA ,f Signature _ Signature Signature <br /> Custody Seals Y/N/NA /YD D Samples Intact Y/N!NA �� Printed Name �� Printed Name Printed Name <br /> Date Time Date Time Date Time <br /> Received in Good Condition YIN Q Samples Accepted Y/N <br /> 06.01-oR <br /> Turn Around Time eoeiv d By t Received By 2 Received By 3 <br /> Signature 14V Signature Signature <br /> Normal ❑ Rush U Same Day 0 48 hrs Printed Rwtfe I, kq`s Printed Name Printed Name <br /> Q 24 hrs Il 72 hrs Kt' <br /> Date Timei Date Time Date Time <br /> Distribution White Laboratory Canary Laboratory Pink ProjecVAccount Manager Goldenrod Sampler/Orlglnetar <br />