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• . ASSOCIATED LABORATORIE* <br /> 806 North Batavia a Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company /", i / ' Phon l Z�� �f A L Job No V I I <br /> J6 r Page of <br /> Protect Manager Faxy� <br /> 5e�t' �2�""v-'�rGC� Analysts Requested fest Instructions&Comments <br /> Protect Name /,y CdA 3 ,, F Project N /y� Q� <br /> and Name ../�r`7 d" Pfd'C -- C.V� R"Y F. �T T 1: I <br /> Address 1-� <br /> } Q <br /> Sample ID Lab ID Date Time Matrix Container Number/Size Pres a <br /> E I <br /> 2 /'N r-1VfJ4r 01, aq. ®�,. 10,z041'P— ,t�� LAP- N©Nk )c X x <br /> 3 <br /> r <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 RehngwV by 2 Relinquished by 3 <br /> Sampler 6C7L�f 4 ?-? . <br /> Total Number of Containers Property Cooled Y/N/NA Signature> Signature Signature <br /> Custody Seals Y/N/NA �� Samples Intact Y/N/NA Print edx�Na�mp4_ tP64,1 Printed Name Printed Name <br /> Received in Good Condition Y/N qc2S Samples Accepted Y/N Date 01 01.0S.Time /y �� Date Time Date Time <br /> Turn Around Time Received Receives 2 Received By 3 <br /> Signature �V r Signature Signature <br /> Normal ❑ Rush 0 Same Day 0 4s hrS Printed Name Printed lKrne ,'` Printed Name <br /> ❑24 hrs 0 72 hrs ' V <br /> Date Time tate �1��� Q� Time (� Date Time <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />