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ASSOCIATED LABORATORIW, <br /> 806 North Batavia • orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-I209 <br /> Company ©f L t'hon 9 Jr 3 pJ, ,� A L Job No ( D f Page of <br /> Protect Manager� r, y, �� Fax �G� CJL�<� ((J Analysis Requested Test Instructions&Comments <br /> p- c �1 t I <br /> Prolect Name Protect# <br /> 4 <br /> Sde <br /> and Name J250 YY W L V1 / <br /> Address =5% <br /> 2 <br /> 0U � J- ` <br /> Sample ID Lab €D Date Time Matrix Container Pres (� <br /> Number/SizeLy X <br /> 2," 05, n v�> 0 *01 lei -/750tO99 Na+V - -4 <br /> 2 i P-1i <br /> 5 <br /> 6 rp-) - qw. A1L <br /> 8 -4 �9-, -4 <br /> )<;,X X <br /> 10 X <br /> 1 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Pilled By Laboratory Relinquishedlby 1 Aelrngw c}by Relinquished by 3 <br /> Total Number of Containers Property Cooled Y I N/NA Signature Signature l'[��+�[ i5 `u 11 Signature <br /> Custody Seals Y!N/NA Samples Intact YIN/NA Printed N� �{}� CA, <br /> Panted Name Panted Name <br /> Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted Y/N D� <br /> Aecery d B Received By 2 Received BY 3 <br /> Turn Around Time <br /> Signatur Signature Signature <br /> �NOI'ma� LJ Rush ❑Same Day ❑48 his Prtnt eJ <br /> �S Printed Name Panted Name <br /> ❑24 hrs ❑72 hrs <br /> Da me e) Date Time Date Time <br /> Distribution White Laboratory Canary-Laboratory Rink Project/Account Manager Goidenrod Sampler/Originator <br />