Laserfiche WebLink
• • ASSOCIATED LABORATORIE6 <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fox (7I4) 538-1209 LM\ <br /> Company 77ig � 6 r L_ co" <br /> Phon 562—)12— <br /> r! ` A L Job No G� Page of <br /> Protect Manager r % ,* �� Fax ppLrf-�r JY q <br /> i.._ iJ /G Analysis Requested Test Instructions 8-Comments <br /> Project Name Project R <br /> Site Name A l/Pp;�rC Wp i <br /> and ka <br /> Address <br /> �- <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 01 <br /> fi 11011 <br /> 7 <br /> 8 <br /> s <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by Rell ui ed bx 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> t'I L�t <br /> Total Number of Containers 7-> Properly Cool /NA Signatu Signature� i Gzf� Signature <br /> Custody Seals Y NA Samples In! /NA Pnnt ara � Printed Name Panted Name <br /> Received in Good Condition 1 Samples Acce d Y 1 N <br /> Date r Time t y t Date Time Date Time <br /> Turn Around Time Re c veil BK'i � 1 .,1f Received By 2 Receive�� 3 <br /> Signature 0] r� C' Signature Signature <br /> 0 U+�, e-1-f1 G"-� <br /> Normal ❑ Rush (J Same Day ❑48 hrs Printed Name Printed Nam ` Printed Name <br /> ❑24 hrs ❑72 hrs <br /> i —Date Time Date 6 Time �) Det , <br /> DrAnbu ion White Laboratory Canary Laboratory Pink Profect/Account Manager Goldenrod Sampler/Onginator A C <br />