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ASSOCIATED LABORATORIES <br /> A\ <br /> 806 North .&xtawa ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 ■ Fax (714) 538-1209 , <br /> CompanyJn' Ph <br /> C �r f i 6 v+l /_'S� A,L Job No t Page of <br /> 16 <br /> Project Manager tie!` F i <br /> 4- UAVAa"5fJ�d Jr6 9�{•- � Analysis Requested Test Instructions&Comments <br /> Protect Name ^ <br /> / i ��•/C ._p t# p q <br /> Site Name `�/�4 '�— POCI A �J [1F <br /> and P B <br /> Sample ID Lab 1D Date Time Matrix Container <br /> Sam <br /> p Number/Size Pres x <br /> 1 EFFLvF OQ.lZ, v� /o: Alp— 47-aG42 APOV0 x <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 Relinquish 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers f Properly Cooled Y/N/NA Stgnature Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Printed Name Printed Name <br /> A• <br /> Received in Good Condition Y/N Samples Accepted Y/N Da� Time Date Time Date Time <br /> Turn Around Time Received� & 1 Received By 2 Received By 3 <br /> Signature Signature Signature <br /> LJNbrmal Ll Rush <br /> L)Same Day ❑48 hrs Printed Name Printed Name 1WPrinted Name <br /> ❑24 hrs ;972 hrs (YU 13 0,0 v-A <br /> Date Time Date Time Date e <br /> c <br /> Distribution White La story Canary-Laboratory Pink Project/Account Manager Goldenrod-Sampler/onainator <br />