Laserfiche WebLink
ASSOCLATED LABORATORIES LA\I <br /> 806 North Batavia • Orange, GA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 . Fax (714) 538-1209 <br /> Company <br /> .Yn, O r L r+ ,� Ppv? G�c ��3��� A L Job No Page of <br /> Project Manager 4CJA I� F a Analysis Requested Test Instructions&Comments <br /> Project Name <J <br /> VI"1 fYJ Project fiSite <br /> and Name 125-0 (-1/ V v 1 . 1 { ) D U,//9-L1 , <br /> / CT <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres <br /> 1, ' 6 its X <br /> /�� �(-t�2 Dx 4�zNt <br /> 3 I`tW � 6: V s" <br /> l'�i --Lr 16.K o l;b)�;- <br /> XXK <br /> 1 �Jr aS� <br /> "yam <br /> ! �'2, ! <br /> Mw -C, 6 M tff1-hloL <br /> Tib $ G. 2. i�i`r�lt�oL <br /> iMw31� WVWOL <br /> 101, <br /> 12 <br /> 13 <br /> 14 <br /> fi <br /> S <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA ,/ Printed Name P Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N '1146-00 Time Date Time Date Time <br /> Turn Around Time Received By JWcotwed By 2 Received Sr 3 <br /> / Sig Signature Signature <br /> ONormal 0 Rush 0 Same Day ❑48 hrs VWed / Printed Name Printed Name <br /> 0 24 hrs ❑72 hrs 1 1x2 ' <br /> `f/2ime Date Time Date Time <br /> A <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />