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ASSOCL4TED LABORATORIES <br />806 North Batavia - Orange, California 92868 <br />Phone: (714) 771-6900 - Fax: (714) 538-1209 <br />Date Y Page of L <br />IDn <br />�05 ��b5�5� <br />CHAIN OF CUSTODY RECORD Assigned LR# <br />r� <br />PROJECT IDENTIFICATION/LOCATION: <br />SAMPLE TURNAROUND TIME: <br />% <br />CLIENT: _357,,� � '�'t7 lkt��/�� <br />Requested Turnaround Time (CIRCLE ONE)* <br />ADDRESS [I i 4 <br />Priority Charges Apply to Rush Turn Around Timms <br />,Ll <br />�'-% <br />PURCHASE ORDER #: A o8Q II Q \ f 1` <br />RUSH: Same Day 24 Hr 48 Hr 72 Hr <br />v <br />v <br />J 1 <br />SAMPLER: (Print AND Sin <br />S) <br />STANDARD: Standard TAT ••(5 to 10 Working Bays) <br />Other <br />Is this the ss the fin�r-eport�too sent Yes No <br />" Availability of Same Day/24/48/72 Hr TAT Varies Based Upon <br />t <br />If "No" list mailing address in `Special Instructions" section at the <br />do <br />— <br />bottom of this Chain of Custody. <br />Test Method Requirements. <br />"Standard TAT Varies According to Analyses. <br />CONTACT PERSON:N <br />� � <br />PHONE #: � U ,-- ( <br />J 1 <br />SAMPLE CONDITION INFO - FO LAB USE ONLY: <br />Samples <br />(� ) l <br />Intact: Yes No <br />SAMPLED BY (Circle One): Client <br />Assoc. Lab Personnel <br />FAX #: (`�, _ <br />Sample Seals Intact: Yes No N/A <br />/ <br />Cooler Seals Intact: Yes NQ N/A 2J <br />Sample ID <br />Sample or Location Description <br />Date <br />Time Matrix (See <br />Codes Below) <br /># of <br />Containers <br />Preservatives <br />Test Re <br />Required <br />t <br />JA i <br />rTT- T <br />MATRIX: GW=Ground Water DW=Drinking Water WW=Waste Water SW=S at S=Solid/Soil A=Air L=Liquid F=Food (Use the codes shown here to identify the matrix above) <br />Relinquished by: (Print ANi )•+• <br />d <br />Received B Print i _ <br />By: ( ! ') Datdrime;4 � <br />Special nstructions: <br />Relinquish by: (Print AND Sign)••• <br />Received By: (Print AND Sign LZ -Date rime: <br />// <br />Relinquishedby: (Print AND Sign)- •+ <br />Re <br />/ciydby Lab for Analysis: Datelrime: <br />/� <br />( AND Sign) <br />/ <br />J%f{ c�- { 1 /k / <br />�V <br />- <br />- <br />` f <br />By <br />***By signing this Chain of Custody you <br />are authorizing the <br />COC DISTRiBUTI N: <br />analyses shown above. <br />(Print ign) <br />White with rrrtnrt Vnlhm 1„ e t o:..i.._ <br />__——___..•...— •auw av —a J,-AWj Gr. <br />