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AssocrA� r.�so��ol�s � <br /> 806 NorBatavia a Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 a Fax (714) 538-1209 <br /> cs3L/ <br /> Company 'f �tl=7` Q t t mane � f?� CJ� 3 J�+#' A L Job No )r ( Page-of <br /> Project Manager Fax -16 Zf 2.1-� -�1- 7-6-XO � Analysis Requested Test Instructions&Comments <br /> Protect Name Q `.t,f Prwect'Tr0 i7 0' -0 0 6-0 41 z C Ic <br /> Site <br /> L! P>t 6 r f C- "+\(,E 7-L-)e I Y� ,% F �`� <br /> Sample ID Lab ID Date Time Matrix Container Pres. a` <br /> Number/Size - <br /> 1 - 6-f 02-2L-0, 15 11%x' 1470 - VoA OCL- X <br /> 2 M w - 41-Lr1O )< 7I. 'K itis C H' PO,,r A LIS iaU-s <br /> 3 �, ' ~ )< x <br /> a [, ' - 12 .50 }c x I I I r--P1+51 <br /> ( 1,t w- 1-b;1 ?r X )c >c M Fri i+ff t+0 I.- <br /> B \ - <br /> s '�-VJt4 X <br /> J-600Mt, F--1-6 r7- <br /> 1 <br /> 13 � f I <br /> r <br /> 14 <br /> 15 f <br /> Sample Receipt-To Be Filled By Laboratory Rernq,,,snea by 1 Rettnquiahed bt►� 2 Relinqurahed by 3 <br /> ler <br /> Total Number of Containers Property Cooled Y 1 N/NA 5ignatu Signature Signature <br /> Custody Seats Y/N/NA Samples Intact Y/N/NA Pruned kA7 Printed Name Printed Name <br /> Received rn Good Corrdrtron Y/N Samples Accepted Y/N Date Time y Date Time Date Tune <br /> 0 �.tiC—l71 T�- <br /> Tum Around Time Received lay ++ 0. 1 Received By 2 Received By 3 <br /> ,f Signature Signature Signature <br /> No 13Rush ❑Some Day ❑48 hra Printed Name Printed Name Pnnted Name <br /> ❑24 hrs <br /> LJ hrs — —�J <br /> Dat Time Date Time Date Time <br />