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ASSOCIATED LABORATORIES <br /> 806 North Batavia m Orange CA 9.2868 <br /> Chain Of Custody Record Phone (714) 772-6900 Fax (714) 538-1209 <br /> Company / 1�7 r Phon .� r��" / A L Job No Page cf <br /> Project Manager p__ Fax7 . J� �� Anafrsis Requested Test Instructions&Comments <br /> 3r?4 -r <br /> Project Name M�f f � br Protea p +� <br /> Site Name �+/ ti t�,- / n "< S� <br /> and b�l t� Fi Y -� <br /> 1� <br /> Address <br /> 9 <br /> Sample ID Lab ID Date Time Matrix Container Press `* <br /> Number/Size <br /> 9:00 14Z.0 <br /> z L9 i Ltd <br /> 6 7'y2[iP $ "V- I wi A X X <br /> z <br /> 8 / <br /> 9 ; <br /> 10 �r <br /> 11 j <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> RelinqSample Receipt-To Be Filled By Laboratory Sampler <br /> by 1 Relinquished by � - <br /> Relinquished by 3 <br /> Sam ter _�.'{r3r�[ <br /> Total Number of Containers Property Cooled Y/N/NA Signature Signature Signature <br /> Printed N�me * Primed Name Printed Name <br /> Custody Seals Y/N/NA Samples Intact Y/N!NA �� <br /> Date Time Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted Y/N a Jy j <br /> Received By 1 c <br /> alved 2 Recerved By 3 <br /> Turn Around Time &0l�� S 11+m <br /> Signature Signature <br /> dNormal ❑ Rush L1 Same Day ❑48 hrs Printed Name Printed Name <br /> ❑24hrs 072hrsDate Time Time Date Time <br /> Distribution White-Laboratory Canary Laboratory Pink ProjectlAccounl Manager Goldenrod SamPter/Originalof `� <br />