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ASSOCIATED LABORATORI <br /> 806 North Batavia • Oramge CA 92868 <br /> f <br /> Chain o Custody Record Phone (714) 771-6900 Fax (714) 538-120 ' <br /> Company�7'j1 - ' ©, � �( Pho ��1 !�3✓0 / A L Job No Page �_of <br /> Protect Manager +G�rr wQ &koSU A-1 Fax Analysts Requested Test Instructions & Comments <br /> Protect Name t�r K�� Prot t o 1 2— <br /> Site Name <br /> and <br /> Address 'S7VC ) C4- <br /> ,4} cJ5ZO Q P T- <br /> Sample ID Lab ID Date Time Matnx Container Pres i a 8 <br /> Number/Size trT <br /> ror <br /> ' Edi uFN nil, z�r r mZ 9 3rO Af P <br /> 2 r Frry ol. Z�. 02 '40 *7P-- /7 Enb"A t4ot4E �C <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> I <br /> 7 <br /> 8 <br /> g <br /> f0 <br /> 11 ' <br /> 12 <br /> I <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by,, 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y!N!NA hr <br /> Samples Intact Y!N/NA Printed Name Printed Name Printed Name <br /> p y �. <br /> Date Time Date Time Date Time <br /> Received In Good Condition Y!N Samples Accepted Y/N 01 7-Lt 02— $:v�J <br /> Received Byrr 1 Received By 2 Received By 3 <br /> Turn Around Time <br /> Signature Signature Signature <br /> Lr 1 <br /> [�Normal ❑ Rush 0 Same Day ©48 hrs Pnnted Name Printed Name plv 0 6. Panted Name <br /> 0 24 hrS LJ72 hrs <br /> r Date Time Dale r+2 Time Date Time <br /> Distnbubon White-Laboratory Canary Laboratory Pink ProjectlAccount Manager Ootdenrod Sampler/originator l <br />