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ASSOCIATED LABORATORIBi . <br /> 806 North BcTtrnna s Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 . Fox (714) 538-1209 <br /> y Phoney /� A L Job No (C7 G & 0Z/ Page of <br /> Company /7 L ®r 1 <br /> Project ManagerK F G ! � Analysis Le Ue5ted Test instructions&Comments <br /> Project Name Project ff f YW— J <br /> Y 2M 0�47T4 PN <br /> t <br /> Site Name 2— <br /> and <br /> Address Zr J l <br /> -J' S tC5 <br /> Containerk -rt- -,JSample ID Lab ID Date Time Matrix Number/Size Pres r t <br /> 1 �3'�a u,� — d L -- 7t <br /> 2 3�Vcsf F{CL� ?a 8260 +r- <br /> 30 <br /> F3d vTL�T` �( —��o>� --' � � Ca a. G, Pa <br /> 4 �L)t LF-� ,l -�o n � ���3 ?� rl� 7n2 <br /> 5 OrI�LF..� _Ups t+��• <br /> s 0 0 i f.f�� <br /> 8 1� 4 '-� " VO4 14 X � <br /> 9 1 LF1 -- VOA 14 <br /> 11 � — V oA t"1��' K X <br /> w - <br /> 12 DURL�c i" � 3- Va,4 NCt-• x' <br /> 13 3 tai 2 — Vf fk 14CU )< X <br /> -72. P!®Lfl <br /> 14 <br /> 15 <br /> 0 UJ <br /> Relinquished byt" 1 Relinquished paq <br /> 2 Reirnqurshed by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sam ler x "31 <br /> Signature Signature Signature <br /> Total Number of Containers Z Properly Cooled Y 1 N/NA <br /> Printed Name Printed Name Printed Name <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA �� jc` u-' <br /> LDale Time Date Time Date Time <br /> Received n Good Condition Y/N Samples Accepted Y 1 N ] 0� 7 <br /> Recei 8�� � <br /> 1 Received By 2 Received By 3 <br /> Tur Around Time {,-p �"��-� <br /> Signature EPnnted <br /> ature Signature <br /> J <br /> ❑Same Day ❑48 hrs Printed Name Name l !rPnnte�dNlarne <br /> Normal Ll Rashp 24 hrS ❑rz hrs <br /> f Date Time Date �}`l Y Time Date! Timer. <br />