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I <br /> ASSOCIATED LABORATORIES <br /> 12-3 ) <br /> } 806 North Batavia x Orange CA 92868 <br /> Chain of Custody Record C Phone (714) 771-6900 ■ Fax (7I4) 538-1209 <br /> ^ Phon <br /> Company-7 fr Ln o f �� �� — Ij � A l Joh No Page of <br /> Project Manager Fax Analysis Requested Test Instructions&Comments <br /> Project Name w Project# f ­1 <br /> 41� <br /> Site Name 11 f <br /> and <br /> Address . 1 i9c,,4M4 C,4 61 v 1® <br /> Sample ID Lab ID Date Time Matrix Container Number/Size It <br /> Pres <br /> it4T: _�' o t�2 -v� ��'�ti H v k X X <br /> 2 ' <br /> 3 <br /> 4 <br /> 5 <br /> 5 <br /> 7 <br /> 8 <br /> 4 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Rehngmshed y 2 Relinquished by 3 <br /> Sam ter Df 24 G � � <br /> Total Number of Containers Properly Cooled Y/N/NA Signal uje'�n Signatur0 v �f21,F1�Cj--�It Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Pnn Nam C)3,C;you Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Da �r Time - � Da1e To Date Time <br /> c <br /> Turn Around Time Recexed ey 1 Rekenret By R eived e�y 3 <br /> F Signature Signat N. / Signature <br /> &�ormal ❑ Rush ©lame Day ❑48 hrs Printed Name Print am Printed Name <br /> ©24 hrs Q7 hrs <br /> Dat Time = <br /> Da tine Date Fime <br /> le-Zo <br /> oistnbutron White-Laboratory Canary-Laboratory Prink Project/Account Manager Goldenrod Sampler/Originator <br />