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i • ASSOCIATED LABORATORI� <br /> ZrY'� 806 North Batavia . Orange, CA 92868 G <br /> Chain of Custody Record Phone (714) 771-6900 . Fax (714) 538-1209 <br /> Company Ph!r6 <br /> tj 6 !2 4 r 3 5-� A l_ Jab No Page of <br /> Project Manager Fax <br /> Analysts Requested Test Instructions&Comments <br /> Project Name /' /t���o�/ 3 r f Project#Site L ) ` 7 n A <br /> and Name ��./'K-t P�ClVI/!V`�r— /tVIE I (fA?-1-6 ( r< l"I <br /> Address b <br /> Sample ID Lab ID Date Time Matrix Container <br /> Number/Size Pres L X iZ <br /> W-6 ,( -oq-dp l3,ov 3 V�^fig HC. - X <br /> Ik LA, _g A 13 <br /> rtw_5-- 1312p <br /> �c <br /> —'� l3 <br /> or -!0 3'4 K <br /> 8 3, <br /> `cp v t-, a- >G <br /> 10 <br /> I 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers 1 Properly Cooled Y/N/NA V Signature Signature Signature <br /> Custody Seals Y/N/NA / Samples Intact Y/N/NA /}� Punted Nam Printed Name Printed Name <br /> Received m Good Condition Y/N Samples Accepted Y/N Da <br /> ?e�r _0 tG� Time Date Time Date Time <br /> ,(If iA <br /> Turn Around Time Recelved By 1 Re eived By 2 Received By 3 <br /> Sign ignature Signature <br /> Normal LJ Rush ©Same Day C348 hrs prJ f Printed Name Printed Name <br /> D 24 hrs D 72 his <br /> D Time Date Time Hate Time <br /> oU Clod <br /> Distribution White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod Sampler/Originator <br />