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. ASSOCIATED LABORATORl <br /> • 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company (�l(r P5+ 2 �2f s <br /> A L Job No Page of <br /> lygitEryProject ManagerAnal sis Requested Test tnstructtons& Comments <br /> y q <br /> Pro eat NameProject It `�rZ <br /> Site Name f _ <br /> and <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> MW 10 JVU 0/ I3 1490 3 VOA Hu X XI I <br /> 2 Kw �4 0 "2-0 X1 I <br /> 3 <br /> 4 <br /> 5 <br /> i <br /> h <br /> 6 <br /> 7 <br /> 8 <br /> s <br /> 1D <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by t Relinquished�sr_ 2 Relinquished 6y 3 <br /> Sample Receipt-To Be Filled By Laboratory <br /> Sampler <br /> �ryW <br /> Total Number of Containers Properly Cooi Y N/NA Signature �r1 t Signature Signature <br /> Custody Seals Y 1 /NA Samples Inta t Y N/NA Printed Namees. Printed Name Printed Name <br /> Received in Good Condor Y/ Samples Accept Y/ Dat r1 Time r Dale Time Date Time <br /> Turn Around Time Received BY <br /> � 1 Received By x Received By 3 <br /> Sig M2 <br /> Signature Signature <br /> J Normal LJ Rush LJ C3 <br /> Day 0 48 hrs P ,r 1 Printed Name Printed Name <br /> C324 hrs El 72 hrsOAJ� -- <br /> p Dat 2 Time /S_� Date Time <br /> Distribution White Laboratory Canary Laboratory Pert, Project/Account Manager Goldenrod Sanmplerlortgtnator <br />