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ASSOCIATED LABORATORIES CHAIN OF CUSTODY RECORD <br /> 606 N. Batavia•Orange, CA 92868 <br /> (714)771-6900•Fax. (714)538-1209 Date � Page��of <br /> CLIEN h I A 1A AL4 Ia � <br /> ADDRESS <br /> PROJECT MANAGER / l,abUseOnly: <br /> L,Q�f Samples Intact Yes No <br /> S N PHONE NUM9ERM-74 <br /> Yes No <br /> 7�l —5q c�5 Sample AmblentCounty Seals act Cooled_Frozen <br /> PROJECT NAME SAMPLERS:(Signalure) Same Day 24 Hr. <br /> Regular 48 Hr. <br /> SAMPLE LOCATION SAMPf E TYPE NO OF SUSP. TESTS <br /> NUMBER DESCRIPTION DATE T WATER AIR SOt ID CNTNRS CONTAM. REQUIRED <br /> 001 LO CI&L ID's <br /> Relinquished by:(Signature) Re iv by(Sign tur ) D tefTl i hereby authorize the performance of the above <br /> 1 ` y indicated work. <br /> Rel uish :( ignature) R elvedby L boratory f nalysis: 1 toe{ ime <br /> (Signatur , a <br /> , 'V) <br /> Special Instructions: <br /> ,[�T-CLP ON &ivy f� Z -rny� 7L5 DISTRIBUTION:White with report.Yell 4L, <br /> JPink to Courier <br />