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ASSOCIATED LABORATORIES <br /> 806 North Batavaa ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 . Fax (714) 538-I209 <br /> Company` o Phone Q 5 /If Page[��C of <br /> I l� rel �! J 2.� �fJ� A L Jab No <br /> Project Manager e �VQ f}lLIJ'5UMtf Fax � Analysis Requested Test Instructions&Comments <br /> Project NameSite <br /> c��_/. LVA509 <br /> and Name 12-5-0 �Y_ A 509 CUJq <br /> I AddressQ <br /> SMCkroh( CA. �'S2,OS <br /> Container ¢ <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres <br /> x <br /> 1 T � �( ��—Z3-o�r 1 3' 20 f 0 -Vol- <br /> 2I�„J—,(n COR Pot)u 4% <br /> 3 �}� �3'3 ` usF t#4 CA 64-50Lrr�F� <br /> akvi— 4 13+40 260 8 <br /> 5 TB— <br /> x <br /> 6 14.00 /%< <br /> 7 x_32 14+D 2- Ma7*t-oL <br /> 16.24 Mira rz- <br /> 1a .A B a�, 2_�fok i4CC- �-AiPF��+ <br /> 11 r eff-6 rr__ <br /> 12 �! <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory sampler F'M-c . C aU3 <br /> Signat Signature ; Signature <br /> Total Number of Containers Properly Gaoled Y N!NA t4� 0 vo-� (i` <br /> Printed Name Printed Name Pnnted Name <br /> Custody Seals Y/N N Samples Intac Y N I NA 5 egg <br /> Qate ame + Date Time Date Time <br /> Received m Goad Condition Samples Accepted /N �� <br /> Received ey 1 Received By-- 2 Received By 9 <br /> Turn Around Time =% i–ea_ z <br /> Signature Si ature Signature <br /> WN <br /> LAA❑Same Day ❑48 hrs Printed Name ted Name A Printed Name <br /> 0 1 ❑ RUSK ❑24 hrs ❑72 hrs V <br /> Time Oate L e �, Date .00 <br /> Ti <br />