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ASSOCIATED LABORATORIES <br />806 North Batavia - Orange, California 92868 <br />Phone: (714) 771-6900 - Fax. (714) 538-1209 <br />CLIENT: <br />ADDREss c� f ' At o,,r`^ �04= J <br />v v <br />Is this the ad s the final report is to be sent to? Yes No <br />If "No" list mailin* address in "Special Instructions" section at the --- <br />bottom of this Chain of Custody. _ <br />0 � � ...� �`� � a� � 5�te a �' l Page � of <br />°' I <br />CHAIN OF CUSTODY RECORD Assigned LR# <br />PROJECT IDENTIFICATION/LOCATION: SAMPLE TURNAROUND TIME' <br />Requested Tumaround Time (CIRCLE ONE)* <br />Priority Charges Apply to Rush Turn Around Tuxes <br />PURCHASE ORDER #: A o9Q I/ Q J / �_ RUSH: Same Day 24 Hr 48 Hr 72 Hr <br />t STANDARD: Standard TAT **(5 to IO Working Days) <br />SAMPLER: (Print AND Sign) Other <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:I j <br />PHONE #: <br />SAMPLED BY (Circle One): Client Assoc. Lab Persoanet <br />FAX #: (� l <br />Sample ID Sample or Location Description Date Time Matrix (See # of <br />Codes Below) Containers <br />' Ya <br />v� <br />d <br />MATRIX: GW=Ground Water DW=Drinking Water WW=Waste Water <br />Relinquished by: (Print ANi )... Y91 _ Received By: (Print . <br />(Print AND Sign)••• <br />Relinquished by: (Print AND Sign)*.. <br />***By signing this Chain of Custody you <br />are authorizing the analyses shown above. <br />Received By: (Print AND <br />dd by Lab for Analysis: <br />AND Si¢n) <br />SAMPLE CONDITION INF0- <br />Samples <br />-Samples Intact: Yes <br />Sample Seals Intact: Yes <br />Cooler Seals Intact: Yes <br />Preservatives <br />No <br />No N/A <br />NQ N/A_ \ <br />Test Required <br />n <br />S--Solid/Soil A=Air I. Liquid F=Food (Use the codes shown here to identify the matrix above) <br />Date?ime:a Special nstntctions: <br />-27 <br />Dateirrimc p <br />J <br />i � a��2--1 1 <br />DatelTime <br />COC DISTRIBUTION: <br />White with report. Yellow to AL. Pink to Client's Courier. <br />