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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia ■ Orcmge, CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 ■ Fax (714) 538-1209 <br /> Company WA_,n Phone 66 {1? A L Job No [ 4 + G Page of <br /> Project Manager �'t�l15V M Fax Z {d 2[ /—Nr-6AOO Analysts Requested Test Instructions&Comments <br /> Project Name KP 144— Project if J /. <br /> Site Name I <br /> and �p `a <br /> Address ,0 t On <br /> Do <br /> } � <br /> Sample ID Lab IQ Date Time Matrix Container Pre <br /> Number/Size s 1� <br /> Ce L <br /> 1 F���rLE12-0 � 1 f: �k t —7 EA t�c�t�r }� <br /> 2 it-ir-w^rc.Fl m 2 �-d !,� rp i lZ ,( >C <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> S <br /> 9 <br /> 10 <br /> i1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished <br /> am qer hed by *j�� /� 1 Relmqu�shted�bL i Rettnqu�shed by 3 <br /> Property Cooled Y/N! Sign �-( •G►� Signature V�1v riQ Signature <br /> Total Number of Containers � Pe Y <br /> Pont m Printed Name Panted Name <br /> Custody Seals Y!N I NA Samptes Intac�/N/NA �rrl p _ <br /> Received in Good Condition Y/N Samples Accepte Y/N Date-L--,O,i jL�ime �t Date Time Date Time <br /> Turn Around Time Rey��!e�g1`��/vhf` 1 Received By 2 Received By mw3 <br /> Signature .-� Signature Signature <br /> Same Day ❑48 hrs Printed Name�2 Printed N me f Pnnted Name <br /> �NOI' I LJ Rush 11 Same <br /> 24 his ❑72 hrs <br /> - � Dat Time Date � 4 5 Time � �} Date Time <br /> _ .. ., _:__..__- ..•..,.........- r..idn..w,.1 Snr..nler/llrinin a4m <br />