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ASSOCIATED LABORATORIES LAk <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company .- . Ph on 5a-aq r <br /> TH of r (✓ ( L 2 2 3 5 '� A L Job No /1 <br /> Project Manager Fax Page of <br /> f=r[ (h E Z) o ) ( - Analysts Requested Test Instructions 8 Comments <br /> Project Name r� Lv Project# f <br /> Site Name �� 1 L f �� Lo � l� r <br /> and 1 Z /5-() 1Y . L.L) r L�{�'rY t.l. .}L -. U <br /> Address • fl L y� �t� <br /> -060 77 0 0�3"2__ <br /> Sample ID Lab ID Date Time Matrix <br /> Container <br /> Number/size Pres ? rX <br /> a t) L1-VUi1 H (-a - X X <br /> 2 4H t L1 1i3 <br /> X X { N �i� C'7�Sr'(.1�t{ F7 t� <br /> 5, X rtD/3 Mr7-117P[1, <br /> 6 �0 � <br /> ] fy rte/ f7lf <br /> T� �� til r✓ <br /> a L <br /> s/ X <br /> MW <br /> x - r�tTF3r7 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample ReceiptTo Be Filled By Laboratory Relinquished by 1 Relonq�rrshe by Relinquished by 3 <br /> Sampler <br /> (Y1�Ls, <br /> Total Number of Containers Vii— Properly Cooled Y/N/NA Sign attue Signature� r r� i Signature <br /> � L <br /> Custody Seals Y I N/NA Samples Intact Y/N/NA Printed Narpf <br /> Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Acceptel_Y/N Date '�� 'J Tome/� ,.. Date Time Date Time <br /> Ur 2- <br /> aQ� <br /> Turn Around Time ReceC-ived By r^�t� Received By 2 Recerved By 3 <br /> -�Lr� � �l�l-?=� <br /> Signature I Signature . , 1 Signature <br /> ❑Same Day ❑48 hrs (, iA`" I�r C—R-t r , �' r.''1 <br /> Norma! LIRush Printed Name Printed Name v Printed Name <br /> ❑24 hrs 0 72 hrs J c <br /> Date Time pate Time Date e <br /> �r C r� itis <br /> DistLaboratory Canery Laboratory Pink ProlseVAeemm Ms n- RnrrI—,M es....o..�n s i ,. _ <br />