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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 • <br /> Chain loCustodyocl Phone 714 771 9 •Record � r } 6 00 F�mc (714) 538-1209 <br /> pe E © 1"L CD 56 A L Bo <br /> 2 �2�r c ��� a No <br /> Company 1Phon Page of <br /> Protect Manager p �' �I Fax <br /> �V U aui__(r,� J5`6 2 V Sko Analysis Requested Test Instructions& Comments <br /> Project Name Pro eCt k <br /> Site <br /> and Name :6"7 ! 'tr7 tom(^ C i+UC=, C <br /> Address �S r-vcK_r V t"i- qt*_ —4 � <br /> J � (� <br /> Cr <br /> Sample ID Lab ID Date Time Matrix Container Number/Size Pres i <br /> 3 i f T'- f- - k iko a�Voik N-C, �C <br /> 4 3 Va J+CL, x <br /> 6 772�e 2,V o ft- <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 1 Relmgylshe by 2 Refingwshed by 3 <br /> Sam ler <br /> Total Number of Containers Properly Cooled Y/N/NA SignatureSignature Signature <br /> Custody Seals Y/N I NA Samples Intact Y/N/NA Prt���am� e _� � Panted Name ! Panted Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Dat , ,3 Time���r� _ Date Mme Date Time <br /> r <br /> Turn Around Time Racei `�f � 9 t Roca ed By Received 6�y 3 <br /> Signature U j^ �� Si Ssgnalure <br /> Normal ❑ Rush U Same Day ❑48 hrs Printed Name GS_rT Te <br /> a e 1� Printed Name <br /> L)24 hrs D 72 his <br /> Date Time 7 ,G Tsme `r tate! Time SO <br /> IZ <br /> Distribution White Laboratory Canary Laboratory Pint Prolect/Account Manager Goldenrod Sampled0riginator D <br />