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ASSOCIATED LABORATORIES LA <br /> 23)0� 806 North Batavia ■ Orcmye, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company r- 1)I L Cr— Phone ,'6 2.,/—3 j A A L Job No Page�_of L4 <br /> Project Manager`•� Fax - ! <br /> j7 Analysis Requested Test Instructions&Comments <br /> Project Name4I Protect# <br /> f <br /> Site Name �� �,�?r�C f y <br /> and <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres Q <br /> !Number/Size <br /> 01 14;00 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> I <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Rel rhgd,ny i Rebn ulshgd 1, M rA_ Reilnctuished by s <br /> Total Number of Containers Properly Cool Y/N/NA Signatu 6�11y Signaattu�ree[uN^� � j Signature <br /> Custody Seals Y/N/NA Samples Intac!:�/N/NA Print `j Panted Names T Panted Name <br /> Received in Good Condition Y/N Samples Accept Y/N Datb'ITime !�,� Date Time Date Time <br /> Turn Around Time Received By '[ Received By 2 Received By 3 <br /> SignatureSignature Signature <br /> Vie / <br /> ❑ Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed Name C Printed Name <br /> ❑24 hrs ❑72 hrs U <br /> Date Time Date 1 Time Date <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/originator <br />