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E _ ASSOCIATED LABORATORIES <br /> 806 North Batu a Orange, CA 92868 <br /> Chain of Custody Record _ E Phone (714) 771-6900 r F7 (714)538-1209 <br /> f fl �• ` <br /> Company, <br /> d I t, CO Phan' 66 i ;�.�l�3 5,V. A E_ Job No i v4�3 Page � � of �5 <br /> Protect Manager Fax ' <br /> �, <br /> �:F 5tj I�KJ1.t1`�yt ;5L y2.t ~ � �l.E„� Analysts Requested Test Instructions&Comments <br /> Protect Name J4 Protect# <br /> 12 ' <br /> Site Name <br /> and Avre, I ii <br /> Address <br /> C> ; 5,?1?c, 4 <br /> t.! <br /> .► }.y <br /> I� Container Fi1. .} <br /> Sample ID Lab ID Date Time Matrix Pres, �. { <br /> Niumber/Size }� { <br /> t <br /> r CL- <br /> 4 i <br /> 4 1P V01), 84 C L XY-Y 1 <br /> � I ! <br /> 7 I <br /> r f � <br /> 8 j to <br /> 1 <br /> 10 <br /> 12 <br /> s E <br /> 13 <br /> 14 I <br /> 15 / t <br /> i <br /> Sample Receipt-To Be Filled By Laboratory i {� RSeetlnq�lrshed by 1 Relinqutsh'd by 0 2 Relinquished by 3 <br /> Signat <br /> Total Number of Containers Properly Cooled Y/N/NA Signature Signature I � �^� � � � I <br /> . r <br /> Custody Seals Y I N/NA Samples Intact Y I N J NA {' Printed ` # I Punted Name Punted Name t <br /> Received in Good Condition Y/N Samples Accepted Y/N 1=I Date _ /}_ 6—Time 4 y J V+ Date { Time Date Turte <br /> Turn Around Time I� �; Rete B,ya /4 ` f)T t Received IBB 2 Received By <br /> f Sign re 1117, Signature Signature <br /> Nomat ❑ Rush <br /> Ll Day 048 hrs Pn�fed ame Punted Name Punted Name <br /> t ❑24 hrs 0 72 hrs '' - <br /> 11 Dateff` Time Date I Time Date Time <br /> 3 l <br /> DistrlbuUm 'While Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Samplerfortglnator <br />