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ASSOCIATED LABORATORIES <br /> Chain o Custod Record 806 North &rtcrvia e Orange CA 92868LA <br /> y Phone (714) 771-6900 e Fax (714) 538-1209 <br /> Company APhon <br /> Protect Manager L � r Fax 2I�R��� A Joh No D Page of <br /> q6w :�U�LI �^ Analysts Requested Test Instructions 8 Comments <br /> Project Name <br /> 3 Protect It y� <br /> Site Name <br /> and <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 3 <br /> t <br /> 4 <br /> I <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 ri$ l 1 Relinquished b �p Relinquished by 3 <br /> Sampler �'� v 4t <br /> Total Number of Containers Properly Cooled Y/N/NA L6 Slgnature Signature Signature <br /> Custody Seals Y/N/NA rrf> Samples Intact Y/N/NA lei Panted N ^ > 0,Popt Printed Name Panted Name <br /> Received in Good Condition Y/N `[6a� Samples Accepted Y/N Dat `�Z�n Time I i,,�p o Date Time Date Time <br /> ed� <br /> Turn Around Time ReceryA � >:�T! Received B 2 Received By 3 <br /> Signature Signature Signature <br /> Norma! J Rush 0 Same Day ❑48 hrs Printed Name Pnnled a Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Dale12- ©2 Time i; Date Time <br /> 1 ' I SCJ <br /> Distribution White Laboratory Canary Laboratory Pink Protect/Account Manager Goldenrod Sampler/originator <br />