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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 Fax (714) 538-I209 <br /> Company O �J f,,� Phone q�1 I r 2 5 p4 A L Job No � �8 Page of <br /> Project Manager f w Fax •G•i J p Analysis Requested Test Instructions&Comments <br /> Ar4r- �u kI�VSV 562 Y q <br /> Project Name { � � Jn,[i� Project-1 <br /> Site Name y d t !^,! L C <br /> and d Q►I G C— �r� 61 <br /> 6CN <br /> a <br /> Address 5�� ^A� , q 6'2-O q A ft <br /> Sample ID `7 Lab 1D �/�Date Time Matrix Container Pres X <br /> Dumber/Size <br /> oF-oar-v� p ,00 IAA- JTF-p l- NoNq X <br /> v v w 2-A- <br /> u, —28 <br /> vw -tA- ?sX <br /> v w - 4,R 2' <br /> JVU) — kC, 12` 0 LXX <br /> vw — 64- <br /> 'S] v w r ( �K -,K <br /> 1+ Vw— �j2� J �}21�1 X <br /> vUUr J `F' <br /> v cv 54 <br /> Y V LL)— 5-e, � )< <br /> 13 Vw- 5C, x X <br /> Sample Receipt-To Be Filled By Laboratory Relinquished <br /> ai�qer hed b J t✓ 1 Rehngi��sh�a b ��2 Relinquished by 3 <br /> Total Number of Containers Property Cooled Y/N l A Signatu hh}f��`l�� Signature Signature <br /> ��j Signature <br /> Custody Seals Y/N/NA Samples Intac /N/NA Printed a�n� Printed Name j Printed Name <br /> Y <br /> Received in Good Condition Y/N Samples Accept /N Date Time 30 <br /> Date Time Date Time <br /> Turn Around Time 05-04 <br /> Recened�y�` ' eWTWZ 1 Received By 2 Received By 3 <br /> Signaatt'ur�ef•��F !�`� per, Signature Signature <br /> Normal Ll Rush <br /> LI Same Day ❑ hrs Printed Name j Printed Name l Printed Name <br /> L3 24 hrs LI 72 <br /> 72 hrs U `^� <br /> Dat Time Date Time r-D Date Time <br /> Is --- <br /> 5-1 <br /> efrhhitn_ nry 11111FLahoMPink =Zcaqer JJJWd ; OriginM M M M M M M 1_ M <br />