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ASSOCIATED ,LABORATORIES <br /> 806 North Botaviar ■ Orange, CA 92868 • <br /> Chain of Custody Record Phone (714) 771-6900 • Fox (714) 538-1209 <br /> Company t Phon _6 2 2 -367 !/ <br /> ' A L Job No ' * � Page of <br /> Project Manager l=ax15 Analysis Requested Test Instructions & Comments <br /> � <br /> Project NameVA-POR, � n M P L9� Projec Y ,r / <br /> Site Name �// A'I f �/t[/ <br /> and ) 2 D t4 i� Z91 CDS r�i <br /> Address 5 > J 6-2 <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres a <br /> Number/Size I- <br /> 2 !I� 1.EJtF — at to X <br /> 3 <br /> 4 T6., 2V <br /> 7 T-?s W 2' ?,a x x <br /> 8 <br /> )< >C ?C <br /> 9 <br /> PW <br /> 12 � � �J• l� l� <br /> 13 <br /> 14 T <br /> 15 <br /> Sample Receipt-To Be Pilled By Laboratory Relinquished by , Relinquished b 14 r A��2� Relinquished by 3 <br /> pler <br /> Total Number of Containers Properly Cooled Y/N/ Signatures S+gnatu� Signature <br /> A <br /> 21 <br /> Custody Seals Y/N/NA Samples Intact /N/NA Print ed�N^m� VvC),S, Printed Name Printed Name <br /> Received In Good Condition Y/N Samples Accepts /N Dat -01-o! Time IC ;�D Date Time Date Time <br /> Turn Around Time Received By (�� ��h 1 Received By 2 Received By 3 <br /> Signature L's"?"1�� Signature Signature <br /> gNormal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed N me , Jv, _ / Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date Time Date Time <br /> it <br /> Distribution White-Laboratory Canary Laboratory Pink ProjectlAccount Manager Goldenrod Sampler/Drig+nator <br />