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I <br /> ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain Of Custody Record Phone (714) 77I-6900 Fax (724) 538-1209 <br /> Gompany-,w,,�•� ir r L �, .p Pho 4,6= i / -35 <br /> / A L Job No 321�D Page of <br /> Project Manager f f'_4 �0 Q f V-06 '�(rJ Fax � ��.JI_1 t,1T y � <br /> 1 Analysis Requested Test Instructions&Comments <br /> Project Name NJ ^ /nL151 / /— Proj �,f /)'2— <br /> Site <br /> 2— <br /> and Name <br /> Address �5 TD 13 t, <br /> Container 4= f— <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres 4 C <br /> r^.t FI.0 F i 01__0_+ +I?- Nook <br /> 3 <br /> / <br /> 4 <br /> 5 <br /> 6 j <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> i1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> she <br /> lr i <br /> Sample Receipt-To Be Filled By Laboratory Samelerr P— 1 Rehnq e yFv� C� Relinquished by 3 <br /> Sam le <br /> Total Number of Containers Properly Cooled Y I N/ A Signal a Signature n Signature <br /> Custody Seals Y!N/NA Samples I ct Y I N�/NA Pnn �pr Pnnted Name Pnnted Name <br /> Received in Good Condition Y/N Samples Accep e Y I N Date Time 1 6,� Date Time Date Time <br /> Turn Around Time Rec%`�y�r,�1 �J O Received 6y 2 Received By 3 <br /> Signaattuur�eLv{J�P�f�f'Vr�'��1, Signature Signature <br /> Normal ❑ Rush 0 Same Day ❑48 hrs Printed Name `1 V ! Printed Na a C� Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date r� Time f-b Date <br /> Ila ry abor ink ccou�er (I rrgina }� <br />