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ASSOCIATED LABORATORIES <br /> 806 North Batavia - Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fm (714) 538-1209 <br /> Company 1WP_�'jr-- ` Phan A L Job No 11�� 1 Page�—J <br /> L SI' <br /> Project Manager qq Fax J <br /> �".(.�;, Analysts Requested Test Instructions &Comments <br /> Protect Name ,.gam- � Protect# <br /> Site Name <br /> and *6-it 1�— lAAad—, <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres Z. <br /> Number/Size <br /> ! 14 x 2--0 4-0�- 11 1,1, H 2 O ilv o r�- 14et, )c k <br /> 2 — <br /> l <br /> 3 ` <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 -- <br /> 16 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> RelinquisSample Receipt-To Be Filled By Laboratory Sampler -by C ti 1 Rehnq is�hetd a tv viii Relinquished by 3 <br /> Sampler ��It.t ..- � _ <br /> Total Number of Containers Ll Properly CooleG/N/NA S+gnat � Signature LJ-:�R rA C.414 Signature <br /> 1-1 <br /> Custody Seals Y/N/Q Samples Intar to/N/NA Print Name + �v+ Printed Name Printed Name <br /> Received in Good Condit n YY N Samples Accept e /N Date Time f Date Time Dale Time <br /> Turn Around Time Recervea By 1 Received By 2 Received s <br /> Signaturer Signature + 'r ' Signature <br /> ormal ❑ Rush 0 Same Day C348 hrs Printed Name Printed Name t, 1 Printed Name <br /> ❑24 hrs 0 72 hrs { t 1 { <br /> • pate Time Date Time /t� �y ime �r <br /> CV s b3 <br /> fi G��nin<.�t� IIS 11• t- IIIIIIIllll1 I_ <br />