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AkASSOCIATED LABORATORIES <br />806 North Batavia - Orange, California 92868 <br />Phone: (714) 771-6900 - Fax: (714) 538-1209 <br />Date S a I l Page <br />�05a�1 o5 -?a) DD0 <br />CHAIN OF CUS TOD Y RECORD Assigned LR# <br />� Of] <br />CLIENT: 3 N I ( �� <br />PROJECT IDENTIFICATION/LOCATION: <br />.— <br />PURCHASE ORDER #: Og0 1 � � <br />SAMPLER: (Print AND Sign) <br />SAMPLE TURNAROUND TIME: <br />Requested Turnaround Time (CIRCLE ONE)* <br />Priority Charges Apply to Rush Turn Around Times <br />RUSH: Same Day 24 Hr 48 Hr 72 Hr <br />STANDARD: Standard TAT *'(5 to 10 Working Days) <br />Other <br />ADDRESS / • A- Pt(-- 7' <br />�J t <br />T <br />Q=�o M1 7 -t7 v <br />Is this the ad ss the final report is to be sent to? Yes No <br />If "No" list mailing address in "Special Instructions" section at the <br />bottom of this Chain of Custody. <br />' Availability of Same Day/24/48/72 Hr TAT Varies Based Upon <br />Test Method Requirements. <br />*'Standard TAT Varies According to Analyses. <br />CONTACT PERSON: N lv <br />SAMPLED BY (Gude One): Client Assoc. Lab Personnel <br />_ <br />PHONE #: 1 U -- <br />(� )---- ------ <br />FAX #: (� l d) — � <br />SAMPLE CONDITION INFO - F R LAB USE ONLY. <br />Samples Intact: Yes No / <br />---- <br />Sample Seals Intact: Yes No N/A J <br />------ <br />Cooler Seals Intact: Yes NU N/A <br />Sample ID <br />Sample or Location Description <br />Date <br />Time <br />Matrix (See <br />Codes Below) <br /># of <br />Cont <br />Preservatives <br />Test Required <br />5_ <br />I k ,Yo <br />r{- <br />„ <br />-Al <br />! <br />L^, <br />I \ 1-sd <br />W\ <br />1--N <br />fl% <br />(3, <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 AN i )-•• <br />Q <br />Received By: (Print AN ign) <br />Datc,Time:4 LL5 <br />ZZ— <br />Special nstructions: <br />/� . f . L <br />1 / �� <br />' v <br />il <br />Relinquish by: (Print AND Sign)••• <br />Received By: (Print AND Sign <br />Date Time: r• " o <br />Relinquished by: (Print AND Sign)•'• <br />Re/ci)xedlby Lab Cor Analysis: <br />( AND Sign) <br />Date/Time: <br />**.*By signing this Chain of Custody you <br />are authorizing the analyses shown above. (Print A tgn)/11 1 <br />COC DISTRIBUTI <br />White with report. Yellow to AL. Pink to Client's Courier. <br />