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ASSOCIATED LABORATORIES /LAk <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain o Custody Record 12_4 �' Phone (714) 771-6900 Fax (724) 538-12 <br /> Company Phon � A L Job No Page of <br /> 1-HAFT" Ur 7 <br /> Project Manager G l 1����r f Fax 5 Z j{ Analysis Requested Test Instructions Comments <br /> Prosect Name Protect q , e--- I <br /> 1-1 i- <br /> M a U1 rte' SA t-t t wo- <br /> Sne Name <br /> andZtJ <br /> r I r7 r� 1 <br /> Address X51 A�cg—, 1 Lm 04. J 0� <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres `� ate'. <br /> {� CO S1— <br /> ov <br /> 'Ca <br /> �3 ;dry t re=riMc i a <br /> 2 0Vi tom ( I's:,1t? 3 - VOA - 14CL <br /> 3 0 U i i.FLT_ 13�otr �! — t�Ohi,fL 1�(v X h�tiC' 4rFz <br /> 4 ;Q7__, P);10 4 — VDA- 14 CL- <br /> , ;NT— 2- <br /> L.5 ;NT— L Q) 20 A - VM 4a, ?� � <br /> V rt Lr 3, r -Vol+ t+ <br /> 8 <br /> s <br /> 10 <br /> 1, <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished�byy i Rehnquishe¢b Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler t7� <br /> Si nature <br /> Total Number of Containers Property Cooled Y I N/NA Signature r Signature()�' � fC } 9 <br /> Printed Name Printed Name i'i PrintedName <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA '�l�`r'` <br /> Datew <br /> Time Date Time fate Time <br /> Received in Good Condition Y 1 N Samples Accepted Y 1 N r j <br /> Recewed By 1 Recei ed By 2cawed By 3 <br /> Turn Around Time <br /> Signature ignature Signature <br /> 0 Same Day Q 48 litsPrinted Name Pri ame Panted Name <br /> Norma! C1 Rush ❑24 hrs C372 his u��'�?j_ 4 C,7/ t <br /> r Tim <br /> Date Time Da � � e ��+ Date <br /> Distribution White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod sampler/Originator <br />