Laserfiche WebLink
ASSOCIATED LABORATORI <br /> • 0 806 North Batavia ■ Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714)538-I209 L <br /> Company 7 I�r O r CO A L Job No {� �✓ � Page bf <br /> Protect Manager <br /> F P- �V`Jr `tw� �� (�2�� ��� Analysis Requested Test Instructions&Comments <br /> I Protect Name &, 4,AV + Protect# // <br /> Site Name '761f� wi i c- e� <br /> fAddress &VC.r���TDf C,n • <br /> Sample ID Lab ID + Date Time Matnx Container Fires <br /> Number/Size <br /> ' FL(1F�T 11-14-0 JOI rI iWlz 114011,I6 �X X <br /> z r FCU <br /> II-A-0/ to:pro 4 t P- and <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> i <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-TO Be Filled By Laboratory Relinquished by 1 Relinquished b� 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers �j Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seats Y/N/NA Samples Intact Y/N/NA + Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y IN Date JJ '6101 Time a( .1 Date Time Date Time <br /> TU Around Time Received B �E (tG 1�J✓ Received By 2 Received By 3 <br /> Signature Signature Signature <br /> Normal U Rush El Same Day 0 48 hrS Printed Name Printed Nme t Printed Name <br /> ❑24 his Ll 72 his �NE V� <br /> Dale Time Date Time Zs� Date Time <br /> Distnbubon White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod-Sampler/Originator <br />