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ASSOCIATED LABORATORI# <br /> 806 North &rtama • Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fox (714) 538-1209 <br /> Company / �i r� © � Ph e56 +��(r a <br /> A L Job No Page of <br /> Protect Manager F <br /> UR KU5f/M/T ��Z Z�—T6,(_0 Analysis Requested Test Instructions&Comments <br /> Protect NameSite <br /> and Name ` L <br /> Address r <br /> t I <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> ' OUTLFF.r 0, 05.o,( 0:Co. H,9 o 3 U10-0 X X4 1 1 1 <br /> 2Lb�7' -4 w.1d IT A XXX <br /> 3 1 f 7 LI: 0 1130 <br /> 4 1 /-/ [- 2 10:20 k <br /> 5 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 4 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Coole /N/NA Signature Signature Signature <br /> Custody Seats Y/N/ A Samples Intact I N/NA Printed Name r, Printed Name Printed Name <br /> wsip�k <br /> Received in Good Con i ion !N Samples Accept Y N Date' 0� 01( Time fY�,�� Date Time Date Time <br /> Turn Around Time Received ! i�V Rece By 2 Received By 3 <br /> Signature Signa re Signature <br /> CU/Normal ❑ Rush Z!Same Day ❑48 hrs Printed Name Printed Name Printed Name <br /> ❑24 hrs 0 72 hrs 12 V C7 Ii JG V1 <br /> Date Time a Time Date Time <br /> 744 Uu <br /> t� Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Driglnator <br />