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ASSOCIATED LABORATORIEO j <br /> • 806 North Batavia ■ Orange, CA 92868 <br /> Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Chain of Custody Record <br /> r <br /> Company -rjfr�'r 0 L CGS Pho ;-6 I r9 2 �-' A L Job No L' ! ��i> Page of <br /> Project Manager/`1 rI �n /L' 7u GVM fj Fax G'i� fj � Analysis Requested Test Instructions&Comments <br /> Project Name IG Tl� Project <br /> Site and!Name (,� p7J r t\=Cc- <br /> T <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres " <br /> Number/Size <br /> 2 <br /> LCI <br /> /0-��.-0 ,I�iN0'o X <br /> 4 <br /> 5 <br /> `I <br /> 6 <br /> 7 <br /> 6 <br /> 9 v <br /> 10 «I <br /> 11 <br /> Y <br /> 12 <br /> {V <br /> T3- <br /> 14 <br /> .1 <br /> 15 <br /> Relinquished by 1 Relinquishedft.,.F 2 Relinquished by 9 <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> Signatur Signature Signature <br /> Total Number of Containers Properly Cooled Y I N/NA `� --�G <br /> Panted Name Panted Name Panted Name ' <br /> Custody Seals Y!N/NA Samples Intact Y/N!NA2gf}}�py��..BU� <br /> Received in Good Condition Y/N Samples Accepted Y/N Date 0-��--o�Tlme Date Time Date Time <br /> Rb �v <br /> Received B�E F 1 Received By 2 Received By <br /> Tur Around Time <br /> Signature Signature /,/Vtr Signature <br /> 2Normal <br /> LISame Day ❑48 hrs Printed Name Print Name Panted Name <br /> ❑ Rush �0 V <br /> ©24 hrs ❑72 hrs ' <br /> Date Time Date Time Date Time ; <br /> I <br /> I <br /> Distribution White Laboratory Canary Laboratory Pink-Proloct/Accnunt Manager Goldenrod Sampler/Oreginktor <br />