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ASSOCIATED LABORATORIES <br /> 806 North &7fcMar m Orange, CA 92868 A\ <br /> Chain of Custody Record Phone <br /> (714) 771-6900 � Fox (714) 538-1209 <br /> Company 1 <br /> P Y 7(,+ale OiL– h o , Phon 6-6 Q q /. ,r err A L Job No <br /> W �(rG,[ D�/ Page of <br /> Protect Manager Fax .� <br /> 'JUS gus Uhr� Analysis Requested Test Instructions &Comments <br /> Project Name V Proj ec N <br /> Site 1�`�Dr,ITJF /h'fl2 5t�hcP� .� <br /> and Name J Z 60 HOP- U l i.S0t4 <br /> Address CA <br /> Sample ID Lab ID Date Time Matrix Container Pres F-1 <br /> Number/Size <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 6 <br /> 4 <br /> ,a <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> i5 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by�� � 1 Rehngmshed�by�L� �L Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled I N 16, <br /> A Signa Signature 4 V Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name ��n�� Printed Name Printed V 1 Printed Name <br /> Received)n Good Condition Y/N Samples Accepted /N Dat �^ r_! Time T,"cv Date Time Date Time <br /> Turn Around Time Receive By" <br /> Received By 2 Received By 3 <br /> Signature ' Signature u}o�ture <br /> Ef Normai ❑ Rush ©Same Day ❑48 hrs Printed Name Printed Namb / Printed Name <br /> ❑24 hrs ❑72 hrs ' V" <br /> Da Time Date Time Date Time <br /> L <br /> n-t.h.a— wh - 4-6-- u.....--- r..ra-.....,r c........ rn ..i......_ <br />