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ASSOCIATED LABORATORIES <br /> mi <br /> 806 North Batavia ■ OrOnge, CA 92868 <br />� Chain of Custody Record <br /> Phone (7I4) 771-6900 a Fax (714) 538-1209 <br /> Company-�-�j Q,�-- d �0, Phon x-6 �2� 1,C� A L Job No L Page of <br /> l r7�(! l Fax "J` <br /> Prolect Manager l ey S 4�M 1� 6 C2-1— ((� Analysis Requested Fest Instructions S Comments <br /> 41 <br /> Pro ect Name `�- Project# /y� <br /> ' -c.P11Nc t va A T C(j <br /> Site Name <br /> and <br /> -14 7- tV Ct - C- rfV;- <br /> Address Is <br /> Container Pres - 4 <br /> Sample ID Lab ID Date Time Matrix Number/Size <br /> 2 0 UT Lcr r '3� VOA HCL itt X2.60 Ir ASL <br /> 3 zU U r tri i -rsV 0,�l,,& 40 t* <br /> 4 l/ T - ��I �t N V v1k 14 CL 7< X <br /> 5 ,t k h 1 V 0A G{- 1S X <br /> 6 <br /> MW AA 16,1; V OtN 14 C4.- X x <br /> ' i 01� I4 C L X 'X <br /> s <br /> y <br /> 10 <br /> it <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished�by 1 Relinquishe by„ Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> Signatur Signature o Signature <br /> Total Number of Containers Properly Cool Y 1 N/NA .�-v—�""'^ 0 V <br /> Printed Name Printed Name Printed Name <br /> Custody Seal ~!N/NA Samples Intac Y/N!NA <br /> Date ff Time y, `ro Hate Time Date�cvTtrne <br /> Recowed in Good Conditio Y/N Samples Accepted !N ` F <br /> Receiv d By 1 Received By 2 Received By 3 <br /> Turn Around Time �jL;�gZg1�` �? <br /> Signature,),,,, �C��I Signature Signature <br /> ❑48 hr5 Pnnted Name Printed Name <br /> Rush l]Same Day Printed Name `t�i�,� <br /> Nal D 24 his (:172 his6Time�f <br /> ` Time Date Time Date <br /> f <br /> feldemod Sarn93le1,10695natm <br />