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ASSOCIATED LABORATORIES <br /> 808 e (7 Batavia) 771- • Orange, ( 92868 <br /> Chain of Custody Record Phone (71�!) 771-b900 ■ pout (714) 538-1209 _A <br /> �7 1 Cool 0 L <br /> company <br /> f f� F''�' d f � � Phan r�, 4 6 2)-3 �J�' A L Job No Page f of <br /> Protect ManiagFeer �J <br /> ti E Fr— &v L'u U 4� Fax�` 5"6 Z} 2.(� �ii Analysis Requested Test Instructions&Comments <br /> Protect Name V D Li ice! G� Pry ! <br /> 7-1 <br /> Site Name �Z� O e ` `.�. i I ry V4 <br /> and ly b <br /> Address ted� <br /> Containerx iQ <br /> Sample!D Lab ID Date Time Matrix Number/Size Pres. <br /> ' EFt=W N i D <br /> CI 0- V )2 00 (� I-T F i1W lqo 4k <br /> z �Nr=Wr--i4C <br /> 3 10 x <br /> ,M�1 !Z� <br /> 5 TB—}2v X2,14 X <br /> +D <br /> 12 <br /> 13 <br /> x <br /> 14 xk <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory RoUnqu"hod by M C -1 Rel�� <br /> rd by 2. Relmq,udwd by 3 <br /> SamplTotal Number of Containers Properly Cooied Y/N! Signature Signature l Signature Signature <br /> Custody Seals Y/N/NA Samples in V I /NA Printed Name Printed Name Printed Name <br /> w� <br /> Received in Good Condition Y/N Samples Accepte&N Date Time Date Time Date ~sr Time <br /> Pte" <br /> Turn Around Time Received By- 1 Received Br Receiv 3 <br /> Signature Signature Signaan t <br /> ❑ Normal LI Rush <br /> El Same Day LI 4a hes Printed Na a Printed Name inted Name <br /> ❑24 hrs ❑72 hrs <br /> C t Date Time L+� Date Time Date e <br /> Otstritartian Vft to laboratory Canary Laboratory Puck-PlotaCVACCourd Manaaw,r Enid—rod <br />