Laserfiche WebLink
ASSOCL4TED LABORATORIES <br /> Chain of Custody Record7 806 North BatcMa IF Orange, CA 92868��• Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company i n �rf © ` e�? Phone O <br /> 1�. S�z y 2•f<�J 5 O A L Job No <br /> Protect Managertoo Page <br /> Protect Name « U t� d II U�� } Fax 5 G 0 J 2,(— xj',( r Analysis Requested Test instructions&Comments <br /> Project�060'7700 <br /> Site Name �a C �� <br /> and <br /> 115 <br /> ri� „ n <br /> Sample ID Lab ID Date rime Matrix Container I <br /> Number/Size Pres C rte" p `� <br /> 2 ALO t-f C� L( —11c71� 1-4 c: , X X t <br /> 3 <br /> a Z'. ?G �C X �C tz <br /> 1 U— r 14 Ci G-> S0afg6;1 <br /> 5 2 2� X X <br /> ? 2_602S <br /> — Nc tFzT 14 4t4ac- <br /> K X X �a 'Tr-EP `I� e3 v1A414 � <br /> a—TRIPt�I,rftt- l t7v_s=� 7__ V 014 t4 t l yC — K — <br /> V <br /> M <br /> 12 r �� <br /> i I <br /> 15 <br /> i <br /> F <br /> Sample Receipt-To Be Filled By Laboratory Reknqutahed byr. C Relrnqu by 2 Relinqurahed by 3 <br /> tib tr.(4 <br /> Total Number of Containers rj Properly CooY/N/NA Signatu Sgnature Signature <br /> Custody Seals Y/N!NA Samples Intac�/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Candd Y N Samples AccepleCYJN Oat 4t _ r„e v� tate Time Date Time <br /> Tum Around Time Recery e .,� Recahrod BY 2 Received 8y 3 <br /> Signature Signature <br /> ©Same Day U 48 hrs D N k e"i-1 i <br /> Norma ❑ Rush Printed Name <br /> U 24 hrs U 72 his Printed N Printed Name <br /> �q J <br /> Date Time Date Time Sw Datee <br /> 61)11105- !t) <br /> Wbtrrbralon 1111hrts-Lab"" Canary Laboratory Pink Praieet/Accourn man"w Cotdaorod ltkiaqutlor 7 _ !-I _ .,r <br />