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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 77I-6900 ■ Frit (714) 538-1209 <br /> Phone <br /> �0A L Job No ILff (5 Page ofCompany d C0 J <br /> Protect Manager <br /> Requested Analysis Fax Test Instructions&Comments <br /> r--,Cf— �u >�i�vsur�r�- 92�� 5'� <br /> Protect Name MO /h�n s � - Protect# / ! -t00 p <br /> and Site Name J2-6-0 HO P,7"N WIC-60,v GU <br /> Address 5 7-0 <br /> a C4ZT-014 ^ �}��� to <br /> L.+'r 3 Container pr <br /> Sample ID Lab ID Date Time Matrix Number/Size es 4 d� <br /> 2-O6-011 12!60 A t fZ ,(-Mt aOW4- X <br /> 2 r?-Fr-LuG.r-1 (2-,9 r0"1 4 flit �(-r'F�C�2 �o�l+� X X `F <br /> 3 <br /> I <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Samplerlhed by� 1 Relmqu3shed b�ymik <br /> Relinquished by 3 <br /> Total Number of Containers Properly Cooled Y!N/NA Sign Signature Oil Fi-".\ 'Ct Signature <br /> Custody Seals Y!N!NA Samples Intact /N/NA Prrnt� <br /> Name Printed Name Panted Name <br /> kASAIA MA <br /> V-A <br /> Received in Good Condition Y/N Samples Accepted /N Dateh r A Time Date Time Date Time <br /> Turn Around Time Retbdy v � ' Received By 2 Received By s <br /> Signature , Signature ~ Signature <br /> ❑Same Da ❑48 hrs ������ <br /> LNormal ❑ Rush y Printed Name Printed Nam Printed Name <br /> ❑24 hrs ❑72 hrs vL�r�►(, <br /> p Time Date ib Time� 019 Date Time <br /> ri-hihminn WhRP Lahnratnry Canary Laboratory Pink Prolect/Accounl Manager Goldenrod Sampler/Originator <br />