Laserfiche WebLink
ASSOCLATED rABORATO714 <br /> 806 North Batavia e Orange, CA 92868 <br /> Chain of Custody Record L.r �" � � Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company / ,`� ' � Phon <br /> Protect Manager �� A L Job No <br /> iJ Page of <br /> Fax <br /> 4. ,�(�(J��fp- p r/�� Analysis Requested Test Instructions&Comments <br /> Protect Name n Protect q <br /> S <br /> Site Name <br /> and tel-yC� �i7,`,/tf f <br /> Address +C5TOc 12 o 04� 9620 <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres ;1e, <br /> 0 2- X X X' <br /> X To6L ox Oe4jc CAM-- <br /> 3 `"/ <br /> 4 <br /> V r fl�.'� % <br /> 8 <br /> �FRLP guoA 474 2-Vi\h-t,s <b, <br /> „ <br /> 12, <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Rehnquishe <br /> Sampler <br /> Total Number of Containers 27 Properly Cooled Y/N/NA Signature Signaturefir}_ e 42X Signa <br /> 4f> ture <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA cJ� Printed Name"I� P Pnnted Name Pnnt ameIth <br /> l J` <br /> Received in Good Condition Y/N �°� Samples Accepted Y/N cf{v45 Date 15.�� Time Date Time Date.2,Z�_a� rine 1 14% <br /> ff 11 <br /> Turn Around Time Received By _e 1 Received By 2. Received By 3 <br /> _/ Signature Signature Signature <br /> Lei Normal Ll Rush Ll Same Day ❑48 hrS Pnnted Name Pnnted 1 t[ Pnnted Name <br /> ©24 hrs ❑72 hrs In R1,1, <br /> Date Time Date r_O Time (f, Date Time <br /> Distnbutlon White-Laboratory Canary Laboratory Pink-Protect/Account Manaqer Goldenrod Sampler/Orlglnator i���tU`j �`z! L/k--- <br />