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' if 1I <br /> r ASSOCIATED LABORATORIES <br /> Chain of Custody Record 806 North Bart=a • Orange, CA 92868 <br /> �� <br /> Phone (7I4) 771-6900 • Fc>7r (7I4) X38-1209 <br /> 1 � <br /> T!-� 1 d�� rte^,�company <br /> ,{� " Pnone <br /> Protect Manager it 2 - �J'7i' A L Job No Page 4a r <br /> Fax <br /> Protect Analysis Requested Test instructions 8 Comments <br /> Name � -1 J <br /> lU�! �t'1 fT 6`�7�t� , �7 /"'tf-�4rlr7 Prat tMi Y `i <br /> Site Name116 <br /> and JZ 6V 4 <br /> Address <br /> Sample ID Lab ID Date fConteaner <br /> Time Matn�x Number/Size Pres -� <br /> 09 11 <br /> 5 <br /> .6 <br /> 7 <br /> iE it � it <br /> ----------------- <br /> 10 II t f <br /> 11 I <br /> 12 <br /> ! j1 <br /> I. I _ <br /> 3 IEpE If <br /> II <br /> i-4 If �I it r <br /> is <br /> - <br /> j Sample Receipt-To Be Filled By Laboratory f' I �� Rsttnqutsited by �� 1 Relinqu�she� <br /> l �- r�1. Relmqueahed by , 3 <br /> Total Number of Containers Property Cooled Y/N �€ li Signature ~ Signature Signature <br /> Custody$gals=N�NMA � Samples t Y N/NA Iii Printed Na. Printed Name <br /> E �' Printed Name <br /> Received in Good Condrd Y Y N Samples Accepted Y N Dat5 1 ro/ ��Time ,v Date Time Date Time <br /> E/T' (;� 1 <br /> Tum Around Time R�tqn,- 4ntame <br /> 2 Received By - 3 <br /> I' O Satre Day ❑48 hrs� S�snat 0 4 C� 1 Signature <br /> Norma! ❑ Rush 0 Prated Name ' <br /> ❑24 hrs ❑72 hmil Printed Name <br /> r Date Time Dat Time 71i �`, Date Trine <br /> � l! <br /> DisVt6ution Whit► Labo►etpry Cart♦ry-Laboratory Pink-Pnfjaet/Aecnnt Mr roger 091d"-gmrvleNoriainator <br />