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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714)538-1209 <br /> Compan ! Pho 5^ ry A L Job No Page of <br /> Project Manager Fax <br /> U f _ Analysis Requested Test Instructions&Comments <br /> Protect Name � � N Protect k f Y n <br /> d C— <br /> Site Name <br /> and <br /> Address c� <br /> Container CL <br /> Sample ID Lab ID Date Time Matrix Pres f— cc Z <br /> Number/Size <br /> i - 00� <br /> VLv -4 n --1�-�� � :moo r�-f� ,17F-41.,� <br /> 2 V w s- 2A / 04 Ax <br /> 3 V w -2.B 16 <br /> V LL) -- $ 2 7E x <br /> s Vw —66 1 ,6 X >e X <br /> tj s w -6C , M.0 r< /11< <br /> 0 V LU -6-14-v kQ ,1 X ' X <br /> tt w _5 B r ���;2- X <br /> 12 V w — X /ti <br /> ,3 LL) - 2 ,I a,�r X x <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relmgul aaw a � 2 Relinquished by 3 <br /> Sam ler <br /> Total Number of Containers Properly Cooled Y/N NA Signature 5ignatut)u p&I�j. Signature <br /> Custody Seals --� !NAS Samples Int t Y/N/NA Pnn ame Pq Panted Name Panted Name <br /> C.,-Received in Good Conddm /N Samples Accepted-- /N Date -Jet- TFme Date Time Date Time <br /> Turn Around Time Recap � p Received By 2 Received By 3 <br /> Signature w+ cS ' Signature Signature <br /> 0[)r- r r L <br /> Normal ❑ Rush C)Same Day ❑48 hrs Printed Name Printed Name Printed Name <br /> ❑24hrs ❑72hrs <br /> Date Time Dale � ( � Time �I'L� Date Time <br />