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• �� ASSOCIATED LABORATORY <br /> 806 North Batavia ■ Orcmge, CA 9286 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 -.L-A <br /> Company VP Pho e V 3 A L Job No � Page of <br /> t Project Manager f Fax G�z - 5�,(U Analysts Requested Test Instructions&Comments <br /> I Pro ect <br /> Proeet Name r7p�— t i ATF- P_ c �( I J 7Z <br /> I, and Name W O - P�C1,-[lc /f / (1 <br /> Site l� <br /> Address S Tz)ce L� l J l_Gt 1 �-, •-• <br /> 1 Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size tom' <br /> V014- <br /> 3 1147- 2- 0 0/+ <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 12 ' <br /> 13 <br /> 14 <br /> 15 <br /> I � <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquishe[�,by,0 2 Relinquished by 3 <br /> Sampler ��f�' <br /> Total Number of Containers 12— Properly Cooled Y/N/NA J Signature �L Signature Signature <br /> Custody Seals Y I N/NA y Samples Intact Y/N I NA I Printed Namen Printed Name Panted Name <br /> Received in Good Condition Y/N `1 Samples Accepted Y/N Dat J� ^0� Time �� Date Time Date Time <br /> M Turn Around Time Received 8, 1 Reserved By 2 Received By s <br /> 1Signature Signature �}, L Signature <br /> L�Norma! Rush ©Same Day 0 4$hrs Printed Name Pnntec�jV�amlL7 !_ �, ) Printed Name <br /> LJ 24 hrs O 72 hrs I) G V <br /> Date Time Date Time Date Time <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod SamplerlOnginatar <br />