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• . ASSOCIATED LABORATORI <br /> !LA\ <br /> 806 North Batavia • Orange CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 • Fear (714) 538-1209 <br /> Company�j�/�j �,T (� ,_3L; A L Job No e of <br /> �� Page <br /> Protect Manager 1 U� f' UM� F rZ pj�/ 7J� 0 Analysis Requested Test Instructions&Comments <br /> V lam- D J 1 t <br /> Protect Name t Protect# 112, <br /> uua'�c � n <br /> Site Name <br /> and <br />' Address <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> X <br /> 1 VUTLA61F J. 14-of 11 'tv 01-o a V p (4CI- CN�p8V F_Ptf <br /> A. 0.? 11 :10 N 10 3 V OA OCL 16 B <br /> 3 lNT- 2 14 OL 11 :20 qo 2 V 0A 4c - XX X z)&rte mrp <br /> 4 �N� � -3 0 ACL X <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> g <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished 5y 1 Relinquishedb 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled YIN/NA Signature Signature Signature <br /> Custody Seals Y 1 N/NA Samples Intact YIN/NA Printed Name Panted Name Printed Name <br /> sF f9 o1) <br /> Received in Good Condition Y/N Samples Accepted Y/N V, <br /> Date�� + Loy Time �j 16 <br /> p t � Date Time Date Time <br /> Tur Around Time Received By 't t Received By 2 ReceSod 3 <br /> Signature Signature Ssgnature <br /> "ormal <br /> Rush LJ LJ <br /> Day ❑48 hrs Printed Name Printed Name Printed Name <br /> LJ24 hrs ❑72 hrs L, V <br /> Date Time Date Time 0 D i; T�? <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod-Sampler/Originator <br />