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ASSOCIATED LABORATORKS LAk <br /> i806 North &atavicr ■ Orcmge CA 9286 _ <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company -tY/�y,r- l Phon 6- r ,ti f� h A L Job No `� r� Page of= <br /> Project Manager Fax 66 „ ,�r Analysis Requested Test Instructions& Comments <br /> Project Name � Protect#Site <br /> and Name 01644— �a tr Zl� �� V rTZ V <br /> L <br /> Address ,�'MC4Z7bf i CA 66W1 �S <br /> Sample ID Lab ID Date Time Matrix Container Pres 5k <br /> Number/Size �— <br /> I � <br /> 2 i fYF�•(✓F t I7� +� � G�# 1f1.2J l�f E2. .— W <br /> 3 <br /> 4 <br /> 5 <br /> s <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> T4- <br /> 15 <br /> Sample Receipt-To Be Filled B Laboratory Relinquished 1 Relingmshed by 2 Relinquished by 3 <br /> p y oraSampler F-M C <br /> Total Number of Containers Properly Cooled Y/N/NA Signal SignatureSignature <br /> f rT--- e��Ji�t4ft'C— f <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name �x Printed Name Printed Name <br /> sa"r �F,_b�.v <br /> Received in Good Condstlon Y/N Samples Accepted Y 1 N flare Time 1 Date Time pate Time <br /> • <br /> �3- 6� - <br /> Turn Around Time Received By 1 Reccilived By Received By 3 <br /> Signature p gna _ gnature <br /> ame Da ❑48 his 0f)eP—t41 &T <br /> ❑S <br /> ,YNorma! ❑ Rush y Printed Name Pr test a e wtf Printed Name <br /> ❑24hrs ❑72hrs <br /> Date Time D e 4 Time I t Date Time <br /> 1 J <br /> Distribution White Laboratory Canary-Laboratory Pink ProfectlAccount Manager Goldenrod Sampler/Ongmator <br />