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ASSOCIATED LABORATORI <br /> `�`5 �1 806 North &rtorv�a a Orange, CA 92$68 <br /> * A <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Compan (9[L. <br /> [L f- Phon CY2 z 7J 674 A L Job No Page of <br /> Project Manager U OWSUM4 Fax <br /> W/f- (J Analysis Requested Test Instructions&Comments <br /> Project Name wp, ,-51fwtY 6— Project 1 <br /> Site Name <br /> and 1250 /11 �11-- 011WA A/ <br /> r <br /> Address 5T0a7&4 7&4 C,f- t1 <br /> Sample ID Lab ID Date Time Matrix Container Pres t-I I <br /> Number/Size xP- <br /> ' IIS <br /> o6.0 0 g,oo u 4TFFDl 2 NoC�> FiRM EW <br /> 2 4 I _I Mr--FHOD <br /> 3 �(B 1/2.Vl, Ia vv )<IX <br /> 4 1 �R:3 d2W <br /> 5 7$ qVv 00 X1 <br /> 6 'r6gw ) bo XxI <br /> 3. �7 766764/ N, � xi <br /> 101 <br /> 11 `� <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by i Relmquishe 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N/NA Signature urs Signature Signature <br /> Custody Seals Y/N/NA 0 Samples Intact Y/N/NA Pnnted Name P Pnnted Name Pnnted Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time Date Time Date Time <br /> Tum Around Time [�Received By 1 Received By Received By 3 <br /> CPC 'e° <br /> Signature Signature Signature <br /> SNormal ❑ Rush ❑Same Day ❑48 hrS Printed Name Pnnted Na tl, ij Printed Name <br /> Ll 24 hrs ❑72 hrs F <br /> Date Time Date cMl6'�,! Time y� Date Time <br /> 9istribution. White-Laboratory Canary-Laboratory Pink Projeet/Account Manager Goldenrod-Sampler/originator J I 1 <br />