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ASSOCIATED LABORATORIES <br /> 806 North Bcdavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 . Fox (714) 538-1209 <br /> Company <br /> 1 77 Jl F 0 C Q4) — c,Phon 56 2 p l U ���� <br /> �[ 7 A L Joh No Page of <br /> Protect Manager Fax <br /> Vy PL /�l�l sW-145_62 —7 3, Analysis Requested Test Instructions & Comments <br /> Protect Dame f 1 Projecl M <br /> Site Name <br /> and 710 C <br /> Address Tl O/O Y�00f 2 2 <br /> iF_ t4 <br /> Sample ID Lab ID Date Time Matrix Container Fires <br /> Number/Size x � <br /> -If FOP. ovy Crd��d-� <br /> Q `2o <br /> 4 coo-t pooN D s 0 <br /> _ t <br /> 5d �'° X c ora-�dra r tz <br /> X x <br /> ' <br /> �>7- <br /> 2v0 ACL <br /> Ti � pEp_ <br /> 12 ,G F_7— <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished bb.... 1 Reimq ed by Relinquished by 3 <br /> Sampler <br /> LT�Z,t {s( <br /> Total Number of Containers Properly Cooled Y/N/NA 5tgnatur Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Pnnted Name Printed Name <br /> Received to Good Condition Y/N Samples Accepted Y/N Date q'.. Timee//7.S_ Date Time Date Time <br /> t Turn Around Time I RecehreC�d�yt� 1 Received By. 2 Received By 3 <br /> Signature Signature Signator`e <br /> Q� I ❑ Rush same Day ©48 hrs Printed Name Pnnted Name Printed Name <br /> C]24 hrs Ll 72 hrs <br /> D Time Date Time I <br /> 1_I s <br />