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ASSOCIATED LABORATORI <br /> 806 North Batavia • Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 e Fax (714) 538-1209 <br /> Companyr a/L �� Z J-9-1-3 68� A L .lob No V�O�� Pa a—.at <br /> g — <br /> Project Manager � VUNfbL 1244 510 Analysts Requested Test Instructions & Comments <br /> I Project Name n` , f 5,q1-1 p f r'4 <br /> 6! 'Project k l y ry <br /> Site Name <br /> and <br />' Address <br />. Sample ID Lab to Date Time Matrix Container Pres <br /> Number/Size <br /> 2 VLA 24, A !3; x x - <br /> 3 v -z S X <br /> ti <br /> uw-3yw- <br /> 5 10 <br /> 6 V WA b, X X <br /> 7 v� I� : x x <br /> xxx <br /> '° <br /> Vw-o x <br /> ,z Vw-CE, 5 +�� y�� X- <br /> 13 <br /> 14 V w <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by t Retrnquisnea�y_ 2 Relinquished by 3 <br /> Sam ]er F�f <br /> Total Number at Containers Property Cooled Y/NJ Signature Signature Signature <br /> Custody Seals Y/N Samples Int t Y N/NA Printed NNm�,,�� Panted Name Panted Name <br /> NA <br /> Received in Good Conditi Y!fi Samples Accep ed Y/)l <br /> Date r Time 1 , , A Date Time Date Time <br /> Turn Around Time Received B��E 1 Received By 2 Received By 3 <br /> Si a Signature Signature <br /> 0 Normal ❑ Rush U Same Day Q 48 hrs a Printed Name Printed Name <br /> ❑24 hrs ©72 hrs <br /> Date Time Date Time <br /> Distribution White Laboratory Canary-laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />