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ASSOCIATED LABORATORIES <br /> 806 North Bafavia ■ Orange, A 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 LM\ <br /> Company ^,Cfje ©! 4- � . Ph q_y LI 2 —Q 6 D/ A,L Job No ��J 7 Page of <br /> Project Manager -� UM 56Z !�n�i�^J�✓�Q�7� Analysis Requested Test Instructions&Comments <br /> Protect Name �y�` � �I,`, `� Proltictit /•G�/� <br /> and Name ..fib rTt �`J�i f c`C `i f^.�[VrL <br /> Address Z7-OdP-TDd C4- J 62.O ,P Container 7- <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres -8 <br /> 1• INFl v � O 9 ill— �ewp— �10 <br /> z rl <br /> A9 1�0X K V w-4cl- <br /> 3 V w 28 1 .20 <br /> eiL) r- <br /> 4 V wz�}- 9 f <br /> G-B g'�n <br /> fi w 6G q :sb <br /> 11 C [o:1U <br /> 9 <br /> \A) �v: <br /> w 3 n' v <br /> io V VJ 6c- fin' <br /> 1 i e SqN, L <br /> 12 �s e <br /> 13 <br /> 14 <br /> 15 <br /> • <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished4b <br /> 2- Relinquished by 3 <br /> Sampler.. ��j��"+ <br /> Total Number of Containers 0 Property Cooled Y/N/NA Signatu Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Pnnt Name p n�Q�� Pnrrtad Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Dat rTimee Date Time Date Time <br /> Y W Turn Around Time Received By , 1 Received By 2. Received By 3 <br /> Signature r Signature Signature <br /> Lf Wbrmal ❑ Rush El Same Day ❑48 hrs Printed Name Printed Name V- 0 Printed Name <br /> C324 hrs ❑72 hrs Ori <br /> Date Time Dale Time Date e <br /> hIM-11.wl-- 4111.n.. I..I.....1.... I'-....... 1 nl.n.nt•nnr iTin4 D-ninN/Ilnnnrrn�Menanar !`nl.�enrn,i rwrnnlnrrArirtinn4nr <br />