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i <br /> ASSOCIATED LABORATORIES LA <br /> 806 North Batavia • Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company Tl � Q I� � Phane�-G Z �' ��a A L Job No <br /> Page of <br /> Project Manager <br /> ,� VU �v ,_ a Fax g` 2�^ � Analysts Requested Test Instructions &Comments <br /> ra <br /> Project Name <br /> -t QN 1� 1 V; � r—�t�l <br /> Site Name 4""C7 P�61 (1C_ �V� /t <br /> and <br /> Address ZS T-©,d,K y r c 14 q6-06,( <br /> _ <br /> CC (tel C Container Cl <br /> Sample ID Lab ID Date Time Matrix Number/Size pros CQ <br /> z I1�f N 01,01-1 10'10 &1"P-- ,l O L&P— 640r16- x <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 1 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by t4 1 Refrnqulsb�a y � ,r, Relinquished by 3 <br /> Sam ler r cam ' <br /> Total Number of Containers Properly Cooled Y/N/NA Signatu Signature Signature <br /> e�.{Vy � <br /> Custody Seals Y/N 1 NA Samples Intact Y/N/NA PrintPrinted Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Dat y ,,,,FSS Time }r_1 Q Date Time Date Time <br /> Turn Around Time Rete e W r ,i �P Reel e+ved sy 3 <br /> i <br /> Signature Signature Signature <br /> L)Same Day ❑48 hrs <br /> @/Normal ❑ Rush Printed Name n am Printed Name <br /> D 24 his ❑72 his � <br /> Date Time ! Time q, r Date <br /> DIstribution. While Laboratory Canary Laboratory Pork Prolect/Account Manager Goldenrod-Sampler/Originator o <br />