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. ASSOCIATED LABORATORIES A\ <br /> 806 North Batavia s Orange CA 92868 i <br /> Chain of Custody Record Phone (714) 771-6900 e Fox (714) 538-1209 <br /> Company /H J�{ � C� L W Ph9?592–)62 —J✓p-f A L Job No �� � Page of <br /> Project Manager IF_r-pt SUS ww6um 9- Fax u l2.( Mo Analysis Requested Test Instructions & Comments <br /> Project Name w � iQ�� �Proj RL <br /> Site Name I � M <br /> and r[ T <br /> Address n T <br /> r <br /> Sample tD Lab ID Date Time Matrix Container Pres , r 8 <br /> _. Number/Size IT <br /> ' l` VW10 oV.Z�, 0z ffl N o 3 Vok 4ci- ?C ?C <br /> 2 M W / Zq.02. 10:10 0 3 v0/+ 14C,1- <br /> 3 <br /> 4 <br /> 5 <br /> I <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 ro <br /> 121 . <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished byD�✓� 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Property Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NA FV Samples Intact Y/N/NA Printed Nam n n Printed Name Panted Name <br /> Received In Good Condition Y/N Samples Accepted Y/N Date Yk bZ Time Vo Date Time Date Time <br /> Turn Around Time Received By-P", 1 Received ey 2 R.!! d ey J 3 <br /> Signature Sg mture Signature <br /> LU Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed N Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Dale Tim+1 111e, 1;2,,,/ 0 <br /> t7istribLQkm. wnite laboratory Canary-Laboratory Pink-ProiwVAccounl Manager Goldenrod Sawler/Origlnator <br />