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ASSOCIATED rABoRATORIE oZ <br /> 806 North Batavia a Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 e Fax (714) 538-1209 <br /> Company C4%,— Phon/12i <br /> _ AL Job No Page °( af_ <br /> Project Manager I Fax <br /> ' t �d?�� . } i�✓s�''��"fir 92 Analysts Requested Test Instructions& Comments <br /> Project!Name 9 t Project# , <br /> Site Name -�° f0 07 <br /> and Yew i� t +'�Y — f� f$ / 10 �6e 1 <br /> Address <br /> rl 'sia�rr tr ��� Vis ` t 9 r <br /> r <br /> Sample ID Lab ID date Time Matrix Container Pres <br /> Number/Size <br /> 1 <br /> z _ <br /> AV r <br /> ail s➢ i� S, 014--Il°x all <br /> 4Y L y71-1 L' iiq,, <br /> s X <br /> 12 <br /> 1314 <br /> 15 / V <br /> Relinquished 4 1 Relm urshe b Relrrtqurshed by 3 <br /> Sample Receipt-To Be gilled By Laboratory l <br /> Sampler 1Ff tt 1C �`�L- �c�t� <br /> Total Number of Containers Properly Coolec(Y/N/NA Signa rey Signature Signature <br /> 1Y/ Pnnled``Ne '1 Printed Name Panted Name <br /> Custody Seals Y!N/NA Samples lataN/NA <br /> a�ti.r^� <br /> Received in Good Condition Y/N Samples AcceptedY/N Date t .' ( Time Date Tlme Date Time <br /> Cl <br /> Turn Around Time Received BY _ t Reserved By 2 Reserved By a <br /> Signature Signature Signature <br /> U Same Day ❑48 Ctrs <br /> 4Normal U Rush Printed Name Panted Name J Panted Name <br /> ©24 hrs (3 72 hrs 1)�Ju`r�"�'} <br /> Dale Time Date Time Et Date r� Times <br /> 1 <br /> Distribution White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />