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ASSOCIATED LA.BORATORI 1 <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> G�51-1 A <br /> Company e t)l Phon rj q 1 Q L= A L Job No Page of <br /> Protect Manager r U fJ Vk Pax b C12� tD Analyses Requested Test Instructions Comments <br /> Protect Name [�� Protect!r <br /> Site Name <br /> and [ <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time MatrixNumber/Size Pres 1 <br /> ' NX <br /> I" <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> i4 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished 1 Relinquis�ugd_b i , ;a:]Relinquished by 3 <br /> Sample Receipt-To Be Filled By LaboratorySa <br /> m ler �e (�^t7L ? <br /> Total Number of Containers L Properly Cooled Y/N/NA 1' <br /> Slgnatur ; Signature Signature <br /> Pant N me Panted Name Panted Name <br /> Custody Seals Y/N/NA VC Samples Intact Y/N/NA (r5" <br /> C Date , Time , Date Time Date Time <br /> Received in Good Condition Y/N Y Q� Samples Accepted Y/N f� 0 Z Q <br /> Receir e3y 1 Received 2 Received By 3 <br /> & <br /> Turn Around Time <br /> Signature Signature Signature <br /> ❑Same Day El 48 hrs Printed Name Panted Name /� � Printed Name <br /> Normal ❑ Rush ❑24 hrs 0 72 hrs ,(D �s� Date Time <br /> Date Time Date � Time f l f t <br /> Distribution vilute laboratory Canary Laboratory Punk Project/Account Manager Goldenrod Sampler/Onglnetor <br />