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606 Norfh Batavia a Orange, CA 9286 Al <br /> Chair Custody Record Phone (714) 771-6900 it Fax (714) 5 - 09 <br /> r� <br /> Company T710 Cn D ' c___ Phorhe 7 L y�a -_� �'� A L Job No Page of <br /> Prosect Manager M.•{{ F Analysis Requested Test Instructions&Comments <br /> j Prosect Name ProleCt N � 4 <br /> I no <br /> Site <br /> Name <br /> and p C(to�- rT rL' <br /> Address <br /> —� <br /> Sample ID Lab ID DateContainer/ Time Matrix Pres <br /> Number/Size <br /> 1 OU r!-F�� 0 x-0'5'0 5- J) ,-00 1 d I_j L ren N z C' <br /> 2 D 0 f (i� 17ct, <br /> 4 i� 1113 4 --Vol FCL �c <br /> Ifo <br /> 6 <br /> 7 <br /> B00, <br /> 9 <br /> 10 <br /> t1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> ReWxpWwd by <br /> sampler <br /> Legr <br /> Sample Receipt-To Be Filled By Laboratory p; Reli _Velpid t4 zt, Reltrtquralted by 3 <br /> Total Number of Containers Properly CoolY/N/NA Signature Signature <br /> Custody Seals Y/N/ Samples Int Y/N/NA 'V- <br /> rint -i'P— Punted Name Punted Name <br /> RecerwW in Good Conditi Y/ Samples Accept Y/N DQt___V.5 Time,(6 J Date Time Date Time <br /> Turn Around Time RegNradT �B1'q --�k Reeeiwa 13y z iieceirea Or 3 <br /> Signature Cqjj Signature Signature <br /> 0 v Fr- <br /> Normal <br /> Day 048 his <br /> Normal Ll Rush Punted Name Printed otJGlr'V Panted Name <br /> ❑24 his. ❑72 his. <br /> Date Time Date Time Date Time <br /> -7161057 r o ► 3.0 <br /> Okkf6uthon white-Laboratory Canary-Laboratory Pink ProlecUAeeouM AteneW Ootderaod-Sampler/Originato► '-- <br /> / 7rJ,^ 7 �a J <br />