Laserfiche WebLink
ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 Fax (7I4) 538-1209 <br /> Company —,/ Phone 3-6 f 1-,(r3 6w A L Job No � Page o <br /> J ((YY1I f ' <br /> Project Manager �� 6Ur? Fax I—�� Analysts Requested Test Instructions&Comments <br /> In?,q2- <br /> Protect Name Alt �1� 519"NIAGI � Prolebt qSite Q- <br /> and Name 64(T <br /> Address rVO}M, r � <br /> c^! rfd''f. <br /> Sample ID Lab ID Date Time Matrix Container Pres p� 4 <br /> Humber/Size , 04 , <br /> _001ft%p— w HO 14 <br /> 3 Vwr4 XI <br /> V w -- ZA- I 11�0 <br /> 5 Vw— Zb <br /> 6 Vw- kk <br /> VW- H6 k2_100 ?� <br /> Vw- <br /> VLA)- 64 2:zu <br /> -,a VLV- Ce) avw <br /> „ w- 6c . -K x X <br /> 12 { fwr �2r <br /> 13 <br /> 14 V u1- 66 <br /> ,5 Vw, G 21t1 <br /> Sample Receipt-To Be Filled By Laboratory Sampler by M ,p 1 Ftetrnqurshed by 2 Relinquished by 3 <br /> Sampler i�1 l.. <br /> Total Number of Containers �� Properly Cooled Y/N Sig Signature Signature <br /> n`t p ? ` <br /> T t V <br /> Custody Seals Y/N/NA Samples Intac Y /NA Printed Name Printed Name SFPrinted Name <br /> q <br /> Received in Good Condition Y/N Samples Accepted Y/N DateTime Date Time Date Time <br /> 62 16�vill <br /> Turn Around Time Recn B , I Received try 2 Received By s <br /> Signature �'s p A� Signature rgnature <br /> Normal ❑ Rush 0 Same Day El 48 hrs Printed Name V I Pnnted N me Printed Name <br /> ©24 firs ❑72 his <br /> Dat Time Date ? 2 Time late Time <br /> niJ Wh, tnry Lnh Plnk t/AcC nagm nrod 10!19 <br />