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ASSOCIATED LABORATORIE <br /> 806 North Batavia • Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-I209 <br /> S <br /> CO'nPanYTft� LY 0l� ^ 1 Phoria �j�Z ^ r O A L Jab No � Page of <br /> Protect Manager �-+[f Fax G L <br /> Pl+r' a�J v 562 q Q r iC.O Analysis Requested Test Instructions&Comments <br /> Protect Name � ProtectSite Name E <br /> andmak� pf{u p t- 4yrz O QAddress <br /> Sample ID Lab ID Date Time Matrix Container Pres _ <br /> Number/Stze <br /> 4. <br /> o-do--v fl o ►01 P- J- r NOarzx x rr <br /> 2 1rFLt1 ; A1)-40-0 /I-lto 11-11Z 1—r�-DI.�FR- NaArr- k K � <br /> 3 <br /> I <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 � <br /> 12 <br /> 13 <br /> 14 <br /> t5 <br /> Sample Receipt-To Be Filled By Laboratory Ralinquist" by _G 1 Relinquished ny-� ' , z. Relinquished by 3 <br /> Total Number of Containers Property Cooled Y/N!NA Signatu Signature V� Signature <br /> Custody Seals Y/N/NA Samples Intact Y!N/NA Print ame Printed Name Pnnted Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Dato. Time Ir J Date Time Date Time <br /> r <br /> Turn Around Time Received By 1 Received ST 2 Received By 3 <br /> Iig�t Signature Signature <br /> W� ormal ❑ Rush 0 same day Ll 48 hrs Pnnt Printed Name Printed Name <br /> ❑24 hrs ©72 hrs <br /> Da Time f/��( Date Time Date ime <br /> (v <br /> n-..a..e.,... wr>.» i�w.,��a,.w r�..�... .ti.,�•...., ns..r e...e..•,a..........v-..-....., r.....-..-.... �..�___." -__ <br />