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ASSOCIATED LABORATO <br /> 806 North Batavia s Orange, CA 9286Aw <br /> Chain4f Custody Record • Phone 714 771-6900 a Fax 4 5.38-1209A <br /> ri Phone / O <br /> Company I �. 5 2- G,� t G A L Job No i' f ` Page of <br /> Project Manager Fax <br /> '6-G L -x1610 Analysis Requested Test Instructions&Comments <br /> Project NamePro eci <br /> � ' � Z <br /> Site Name <br /> and <br /> ��p, mss~ y <br /> Address T–D1 t4�•'� tJrr J�� + , ,4O <br /> Sample ID lab ID Date Time Matrix Container Pres cit <br /> Number/Size 1c <br /> z i N PLO F rf'i 0'Ito X <br /> 3 <br /> V 1rt!- l -4)0 7� <br /> 5 <br /> 1w` k`242 <br /> 6 <br /> 1N - x <br /> Vw- kit <br /> s Val- Gt�a X <br /> 10 <br /> Vw- <br /> 1 z 1i IA!- 9c13 6A- <br /> 14 Vw#- Cg X ?c <br /> 15 VVV- t~C/ l3'�,� jc 'X <br /> Sample Receipt-To Be Filled By laboratory Relinquished by 1 Relinqutshed eyg,t3,o 2. Relinquished by 3 <br /> Sa ler <br /> Total Number of Containers Properly Cooled Y/N/pIA Signature Signature Signature <br /> Custody Seals Y/N/NA Samples lntaco/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accept Y/N Date Time Date Time Date Time <br /> 'L (T _vim <br /> Turn Around Time Received By �. � Ck) i Received By 2 Received By 3 <br /> Signature Signature Signature <br /> Normal ® Rush o Sake Day o 48 hr� Printed Name Printed a e J Printed Name <br /> ®24 hrs U 72 his Ii,i."t <br /> Date Tire Date Time Date Time <br /> mstribwion White Labarat�y Gan sry 'aborz cry P,rx P-olecJAccowEt Manager Goldenrod Sampler/Grlg"or <br />