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i . ASSOCIATED LABORATOR.W <br /> 806 North Batavia ■ Orange, CA 92868 _ <br /> Chain of Custody Record Phone (7I4) 771-6900 Fax (714) 538-1209 <br /> Company ' P on'g J ^3 A L Job No �r Page of - <br /> Protect Manager �� ���3 U fa} Analysis Requested Test Instructions&Comments <br /> Protect Name ys� r11/ t f I'� n�f 1/C rotect <br /> Site Name <br />� and <br /> Address IT <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size k Fr <br /> VtV4 �J 'Sc� �� u <br /> )0,00 X �C <br /> 5 Vw Zg Q��,10 <br /> 6' Vw 3 101-7 EE X X Ki I I <br /> V W 4� i ��'k / /X <br /> V wits �a�SU X \/<Ix, <br /> ' V to fiG 11 ,210 X X ?� <br /> 130 <br /> o <br /> vX <br /> 14 v � <br /> VW <br /> Sample Receipt-To Be Filled By Laboratory <br /> Relinquished <br /> alta leashed by 1 Relinquish F�� 2 Relinquished by s <br /> Total Number of Containers Properly Cooled Y/N/NA Signature l Signature Signature <br /> Printed Name i� Panted Name Panted Name <br /> Custody Seals Y/N/NA Samples intact Y/N/NA me <br /> {)">P w <br /> Time Date Time Date Time <br /> Received in Good Condition Y/N "� Samples Accepted Y/N Date 03 0! 1� i 00 <br /> Received B 1 r, ) 1 Received By 2 Received By 3 <br /> Turn Around Time ��� <br /> � <br /> ,/ Signature Signature Signature <br /> f.� Normal ❑ Rush Ll Same Day Ll ae hrs Printed Name Printed Name ti Printed Name <br /> ©24 hrs U 72 hrs '-3 Q t-4 b U V <br /> Date Time Date V Time Date Time <br />