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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 s Fax (714)538-1209 <br /> Company 1 6{K+f�^ Phone 562. ^ —3'5gJ"'C G� I <br /> A.L Job No ( Page--ZL of <br /> Project Manager Fax <br /> �r-p- ��I }G(j5(IJ�14" J�S2 611 Analysts Requested Test instructions&Comments <br /> Project Name V <br /> T� Project O, V�D�O� <br /> Site and Name 9L . Cu-Y `T -,I-- P,6 Z/I F-T%r— R'Y <br /> Address S 7-D C47-Z) 9 5 2 0 4 0 <br /> Sample ID Lab ID Date Time Matrix Container Number/Size Pres' C14 k <br /> v$- -v4 R, -V014 k t✓1, xi K x �wtal&z p..,0 fp,G,D <br /> z 43:LO I X /X K X I I pop- C0 1-,P9(.)9,045 VS56 <br /> 3 UJ- 2S IH C4� 0-#S0 r" $ <br /> 4 y%0 X RUoES 2 <br /> 5 <br /> Mw— k.00 X <br /> fiMw- <br /> 7h--+ rflc- <br /> g 6,. x 3 vv voc— <br /> g � e0:.r't? 2—V 0A X , M.Ebk- <br /> 10 <br /> z <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinqutshed b M. 1 Re[mgmshed_by ;5 folk Relinquished by 3 <br /> Sam ler <br /> Total Number of Containers '� Property Cool Y/N/NA Signa Signatu a V Signature <br /> Custody Seals Y/N/NA Samples lntactC/N/NA Pnnt d Name u Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accept / Date Time Date Time Data Time <br /> Turn Around Time Recej d 6 ww S1 Received By 2 Receivedr.— 3 <br /> Signature 0 SignatureSignature <br /> Same Day 0 48 hrs Printed me Printed Na a Printed Name <br /> Norfi181 - ❑ Rush N❑24 hrs ❑72 hrs `� <br /> DataTime Date Time %4e D e Time <br /> r�1� r <br /> Whi o pi tUA anag rc er/Qr <br />