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• ASSOCIATED LABORATORI* <br /> 9 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 is Fax (714) 538 1209 -LM\ <br /> Company 11421 01 (— Ph !Lb � J(1 <br /> A l Job No t Page -*of <br /> Project Manager YW�-- S&w ijQL1412, „ f,r Fa r <br /> /" e �� � (,� Analysts Requested Test Instructions 8. Comments <br /> Project Name 4 S Project p 'f-2— <br /> and Name <br /> and "7 (/ t r 1t M <br /> Address SM 0�2m� / C <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> lir <br /> 3 V w 1 -2, 20 x <br /> 4 VW -2-4- -' <br /> B V w q ii w / XX <br /> 10 <br /> 11 X <br /> 12 <br /> 13 <br /> 14 <br /> t5 <br /> Sample Receipt-ii To Be Filled By Laboratory Relinquished <br /> eli qui hed by y �I Relinquish e�yL� Relinquished by 3 <br /> Samper <br /> Total Number of Containers f Properly Cooled Y/N/NA NIA A Signature Signature Signature <br /> Custody Seals Y/N/NA rJ Samples intact Y/N/NA f�t� Printed NaEngPrinted Name Printed Name <br /> Received In Good Condition Y!N Samples Accepted Y/N Date©, V o L Time rt �.f90 Date Time Date Time <br /> Turn Around Time Recelven ,� iet I} deceived By 2 Received By 3 <br /> 1 <br /> Signature ( �` Signature 1 Signature <br /> Normal ❑ Rush Same Day ©48 hrS Printed Name Printed Name V �� Printed Name <br /> 0 24 hrs 0 72 hrs <br /> Date Time Date Time. Date Time <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />