Laserfiche WebLink
ASSOCIATED LABORATORIES <br /> 806 North Batavia + Orange CA 92868 0 . , <br /> Chain of Custody Record 12—LI q 9 q Phone (714) 771-6900 111 Fox (714) 538-1209 <br /> Company �n� I Q! Phone 5W q���y p/ a <br /> I I7gL 0% A L Job No Page of <br /> Protect Manager Fax <br /> 9 � �(2(f�JM,� r�.'b Analysts Requested Test Instructions& Comments <br /> Protect Name '' M014+ � �r? i� p�*I` `ro! 1YZ <br /> Site <br /> and Name �O 4 1` P,�1(4}v`L c- f 7 <br /> Address �Ip� C� .1�•y ,ry ,/ <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size <br /> q 'io X1111 <br /> z iNAL A0 <br /> VW- 249 Woo <br /> 5 <br /> \/w- <br /> 6 2Q, • �to,� ?< <br /> 7 V _ 14g • to, X <br /> B V w— 4 G, to-Ltd X �C <br /> g V -• b [0" 'J0 %< KI <br /> 1t) ` t '00 x X <br /> 1, <br /> \jw— 6c . ll ;10 <br /> 12 ,f - 3 <br /> 14 <br /> v VV— 56 . <br /> 15 ViW6c,— 6 <br /> Sample Receipt-To Be Filled By Laboratory Retmgwsh�+ 1 Relaq Ishe H bx ..� 2 Relinquished by s <br /> Sam ler <br /> Total Number of Containers Property Cooled Y/N/NA Signature SignatureOF `'p Cml Signature <br /> 1p Custody Seals Y/N/NA Samples Intact Y/N/NA Printed ane a P� Panted Name rFi r 1 Panted Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time j i Date Time Date Time <br /> Lr12—���� .JY111) <br /> Turn Around Time <br /> Received 1 Rec y s Received By a <br /> Signature �} Signatur Signature <br /> 0 11 F-Rw rw <br /> Normal ❑ Rush Q Same Day ❑48 hrs Printed Name Prinle Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date Time Date Time <br /> q.r c <br /> Distribution While laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod Sampler/Originator <br />