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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange, CA 92868 A\ <br /> Chain of Custody Record Phone (7I4) 771-6900 ■ Fax (714) 538-1209 <br /> Company 1h, Ol-- C ' Phone �6L 1` /-3 T/ A L Job No � �' qR <br /> 1.J( Od�l Page <br /> Protect Manager Fax <br /> SUM pf- 6'6 2 12.1—X642 Analysis Requested Test Instructions&Comments <br /> Protect Name r7 V wProtect <br /> �`�y�Ole ��i'B�"/Li fJ L16��� coSite cc <br /> and Name 6 r V t4. (V 11- .5(9 i,lf w O <br /> i4 <br /> Address `'• <br /> Container a` k <br /> Sample ID Lab ID Date Time Matrix fres <br /> Number/Size S <br /> 3 TP,—t2v 11 ' <br /> 4 113 w x x <br /> 5 -- V <br /> rg - 11 V IV 00 X X X <br /> _�- L2t-7,o ! <br /> W-6'- 1.>C <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laborato Relinquished by15. 1 Rehnqulshed b Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Property Cooled Y IN/6 <br /> Sign re Signature Signature <br /> Custody Seals Y I N/NA Samples Intac Y�I N I NA Panted a e Printed Name Panted Name <br /> Received in Good Condition Y/N Samples Accepted l N Time Date Time Date Time <br /> Turn Around Time Recglv_e "(ehy -�? Received 6y2 R Ives By a <br /> 2TIArSignature * <br /> Signature Signature <br /> ❑Same Da ❑48 his 0 v�� k C7'�r <br /> ILd Normal LJ Rush y Printed Name Printed Namd <br /> 6 Printed Name <br /> D24his C3 72 his fty <br /> bat Time Date 2 'S e Time 'Q�-p Date Time <br /> n:ernhi Jinn WhiTn-1 ahnratnry f`anarv-1 ahnratnry Oink PrrnnctlArcnunt Manaan Goldenrod SamnleNOrlalnatnT <br />