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ASSOCIATED LABORATORIES <br /> 806 North Batavia a Orange CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 ■ Fax (7I4) 538-2209 <br /> Company Prt n ` Phone Q 3 L�'J 1 A L Job No J -r Page of <br /> Protect Manager �, �KvS[JM Fax 6', 2� � ,(�> Analysis Requested Test Instructions &Comments <br /> Protect Name V Prot O 6 0`7 tv-�0 (a Cfl o9 <br /> r 7 .� <br /> GI F -F0 <br /> a <br /> nd Name �Z Op <br /> and �T � <br /> Address <br /> gTor�1-nN CA . 95zn <br /> Sample ID Lab ID bate Tlme Matrix NumbeContaine <br /> r/Size Pres �e <br /> mw-5 P WAC 07 D 4U- X X <br /> 2 M ,i3:3, X X Pad eampow4o's u <br /> 3 t4 W_ !r< :� }c rrR er4. &*aOfiP�hft 8 <br /> 4 MW4 V-P,4 MaTlioibi Rue. <br /> 5 <br /> 8 Kw-)J <br /> )6.S6 it I <br /> 10 z?Tp <br /> .z <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by i Retrnqutshedy r fr Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler M c <br /> Signa Signaturen �?�.7� Signature <br /> Total Number of Containers I Lt Properly Cooled Y!N!NA 0 �J= ) <br /> PrintedName Printed Name Pnnted Name <br /> Custody Seals Y/N/NA Samples Intac Y!N/NA 14�k -d_ POP <br /> Date Time 'v O Date Time Date Time <br /> Received in Good Condition Y/N Samples Accept /N <br /> Received By 1 Received By 2 Received By 3 <br /> Turn Around Time [,-0�+.j N 7`7 <br /> Signature 9 Signature Signature <br /> U_ C � <br /> 0 Same Day ❑48 hrs Printed Name Printed m Printed Name <br /> -No i ❑ Rush ❑24 hrs ❑72 hrs -vb "� v�/ <br /> Da Time Dater f Z Time p lime, <br /> r.___ --------- rawe...,,,i ee..,,anrin.irnnatnr t / <br />