Laserfiche WebLink
ASSOCIATED r.ABORATOR <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Pcff (714) 538-1209 <br /> Company ;�T F� t � Phon / „� / r1 e <br /> 11 �: 1 t t+ 7 A I Joh No p page I of <br /> Project Manager 1 �, Fax ; 1) �0 Analysis Requested Test Instructions&Comments <br /> Protect Name y�y l Project N J t L <br /> Site Name <br /> and 1 -/, <br /> J <br /> AddressContaine <br /> Sample ID �t Lab ID Date Time Matrix Number/Size Spros I� <br /> X <br /> 2 = <br /> 3 v -2. <br /> 4 Vim _ <br /> t•t- - <br /> 10 <br /> U I j5 C^, W, <br /> t1 V . ! �— 1 W0P <br /> 12 s Wi ' lC Ike/13 OLU— b6-)c <br /> f <br /> 14 F,�IvFtll K I <br /> Aelrngwshed py, t Relinquished by Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> Total Number of Containers Property Cooled Y/N/NA Signat r t,->L— <br /> Signature Signature <br /> PrintPrEnted Name Printed Name <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Na y s_ <br /> Received in Good Cond:tion Y 1 N Samples Accepted Y!N Date L),�T ime 1+ Date Time Date Time <br /> Turn Around Time �, _ <br /> Received B , -/ Received By 2 Received By 3 <br /> (,�' <br /> r Signa <br /> W/ ture Signature Signature <br /> Normal L) Rush C)Same Day U 48 his Print d e Printed Name Printed Name <br /> I� 0 24 hrs 0 72 hrs <br /> Dat t 0� Time Date Time Date Tune <br /> Dish*irhon White Utioratory Canary Laboratory Pink-ProjectlAccounl Manager Goldenrod SampierfOnginator <br />