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ASSOCLATED LABORATORIEn& <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (7I4)538-1209 <br /> Company,T � f �f C_ CO `No qu _J-524 AL Job No Page of <br /> Protect ManagerF <br /> Ff- Fax�] f EZ 2� p-`7 6,40 Analysis Requested Test Instructions&Comments <br /> Protect Name Protect# � <br /> Site Name 1"e rnll�/rt P ' <br /> and l�"[ � l��c 4 yc— <br /> Address V-0 CA 01 6_10 9 v <br /> Sample ID Lab ID Date Time Matrix Container Pres 4 <br /> Number/Size <br /> 4 "09 111 <br /> ,, t <br /> 3 dcT�lik� 0 .ccs �,�� t4o9 <br /> {Qi --4 wu I 3VOA- 14C , IX <br /> 5 ! W7 L. 10,20 aJ V'Old 4 CL ?{ <br /> s tAw—ko lo'�O Is VO+ 4CL <br /> Ito v 0A t4 C L <br /> 10:5 O A H C'1_ KC <br /> 9 top 1-ii C�lr O d �s lUfo l��yT ,4 c l_ I-,,< <br /> x <br /> 11 <br /> 12, <br /> 13 <br /> 14 <br /> 15 �' <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by,��"� 1 Relnnqurshed by 2 Relinquished by 3 <br /> Sam ier p®r-i�tra'r� Di �� <br /> Total Number of Containers Property Cooled Y/N/NA Signa Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N DatOO�� Time Date a ate Time <br /> Turn Around Time Received By_ _ �t Receive y c ived By 3 <br /> Gry(�� <br /> / Signature Sn gnature <br /> a Norma! ❑ Rush Ll same Day ©48 hrs Printed Name -Printed Name <br /> ©24 hrs ❑72 hrs - '✓� <br /> Date TimeDae Time �I OateZ f Time <br /> J 2-3 <br /> Distribution White Laboratory Canary Laboratory Punk Proted/Account Manager Goldenrod Sarnpler/Originator <br />