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0i ASSOCIATED LABORATORIEJ <br /> 806 Norfh Bartavncr -, Orcmge CA 92868LA <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company ^ttn`!'� ©' �,dy Pho � J +� I L(} / A L Job No [ [ LPage of <br /> Protect Manager G w �M Fax �6 q42 !" 7J ``51 Analysts Requested Test Instructions&Comments <br /> Protect Name Q 1 Protec N� <br /> aSite nd Name T64� Pl CI f-1 c fv1 r[.� <br /> Address } y^ T' <br /> Sample ID Lab ID Date Time Matrix ContainerPres <br /> Number/Size <br /> v LL) --A 50 )k P, 4T5—Q �Ap- NvNP- X X ,X <br /> 2 W — f({)'001 <br /> 3 Vw- 9-K <br /> v Lit--tt C tot 0 X <br /> Lu, vo X <br /> 9x <br /> V U! '-6,& <br /> 1a V y t _ A�� X X <br /> V <br /> 11 1 ¢lrtny Vt —G4 XJ < <br /> 12 V (V -6$ r4( X /` <br /> 13 Xxx <br /> �1 <br /> 14 FlT+- E r< '� /x � /1 <br /> 15 rN rLiF?4 �-, X X <br /> Sample Receipt-To Be Filled By LaboratoryI�geisited b igi� 1 Retinq„uLe�r„ � 2 Reimgwshed by s <br /> Total Number of Containers �' Property <br /> Cooled Y/N/ A Signat a Signature �zN Signature <br /> Custody Seals Y/ !NA Samples tntac Y /NA Printed Name Printed Name Panted Name <br /> Received in Good Condititxt Y Samples AccepteeN Date Time Date Time Date Time <br /> Turn Around Time Receive 1 Received By 2 Received By 3 <br /> g re Signature Signature <br /> LD Normal ❑ Rush ©Same Day ❑48 hrs Pn t e Printed Name Printed Name <br /> ❑24 hrs ❑72 hrs <br /> p Ti Date Time Date Time <br /> Distribution WNW taboratorY Canary Laboratory Pink Project/Account Manager Gotdonrod-Sempled0riginator <br />