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.r rAWDBa a07A\ <br /> 806 North Batrnncr • Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company �Q Phon 121;—3 5' A L Job No J��(`t/ <br /> � W- ' P Page of <br /> Project Manager ISL i�l U Fax 5r,L 2-A_y Analysts Requested Test Instructions& Comments <br /> Protect Name J t vl l'T t L <br /> andName P <br /> and "l d'" 1" <br /> Address L�1 � o LOp ' <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size P' <br /> 2 , r ` "Ce 3 V n4 rf CL <br /> 3 V <br /> 4 t R7u- - [11. 10 k-VOA HtL IK X <br /> ti —VOA 14Cif, 7C <br /> - 6 Q -VO4 <br /> 9 <br /> 1b <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Lab ratory Sam le Relinquished&, 1 gelingplshad bye ` Relinquished by 3 <br /> Sam ler V D trt.[`t <br /> Total Number of Containers Properiy CoolN/NA Signa Signaturo r �r 1gnature <br /> Custody Seals Y/N/NA Samples Intac / /NA Pnntgd�V1% h,e p,C%Z� Panted Name Panted Name <br /> Received in Good Condition Y/N Samples Accepte Y/ Dai y� �`Timre of,,i Q^ bate Time Date Time <br /> Turn Around Time Received By i Ov Received By s aeceiVVBy� 3 <br /> t a-M'?' <br /> 5ignatu0 u�+1 l Signature Signature <br /> 0 Same Day ❑48 hrs printed Name t�F Printed Narhe Printed Name I <br /> Normal Ll ❑24 hrs ❑72 his VJ <br /> Date Time Date Time Date Time <br /> 7- 15 !d f° P vo <br /> Distribution White-Laboratory Canary,,„Laboratory Pink-Project/Account Manager Goldenrod Sampler/Originator <br />