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ASSOCIATED LABORATORIES LA <br /> 806 North Batavia ir Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 7716900 Fax (714)538.1209 <br /> Company +fii Q r Phone �6 A L Job No Page X of I} <br /> Pnoiect Manager les � � Fax ,J Analysis Requested Test Instructions&Comments <br /> Solekj vi <br /> L7 F so imp trz <br /> and Pranec Jfi <br /> and oma -{�' WJE Gt C 4-VE-. �4 TO 60 IV 006'0 <br /> LL, C' <br /> ti <br /> Address <br /> J�., I CI) y <br /> � Vf s <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/SizePros. t o loo A � <br /> Mw- q 04-3o,9� ri:3 0 it—VO4 14CL X �Jx X �t'3w6ew 4S <br /> _Z5 z 4—voh- 14 pop, c4t�poot z% LFdjjb <br /> - � D–a l�Cl,o a 1tlOd• l Jt`T C ' SIA .-{ <br /> 5 <br /> 2 � �� fl� <br /> to <br /> 4 <br /> 0 11 <br /> c <br /> a <br /> ro 12 <br /> 3 13 <br /> u 74 <br /> a <br /> to <br /> 4 15 <br /> i <br /> Sample Receipt-To Be Filled By Laboratory Rel,nryulshed by �� � i Rahn ofsried„ h�. '! g � Helingwsnad by <br /> Sam ler <br /> Total Nambor of Containers Property Cool Y f N l NA &rgnatur _ Signa eS+gnalurd <br /> Custody Sears Y!1a J f FA Samples tnsa Y N!NAPrmted Name Panted Name 11 Pdaled name <br /> ZA <br /> Recelead in Gond Corxld+an Y f N Samples Aoceple pate Time y r Date Time Elate Tme <br /> ca Flee �--,�� r�,{^#� Received By 2 Received By <br /> 3 <br /> Turn Around - <br /> ca Signature °7 Signature Stgnalure <br /> 0 k v a <br /> C> U NOi— Rasa i3 same day ❑ hrs printed Name Panted N Pnnied Name <br /> 0 24 hrs L�`72 hrs <br /> Dale Time pate Time Da Tme <br /> _ �- •a <br /> ry P reVR nred r�t7rtgfna wow <br /> � � i imter. � <br />