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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Qi mge, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company . t Phan 2 r� '1O q L Job No Page of <br /> L C- J O <br /> Project Manager Fax 562 9z�( Analysis Requested Test Instructions&Comments <br /> -�5� <br /> Project Name V 4 Po Q 5 A M P L4at4c� Project Y <br /> Site Name �nf / <br /> and 4 6-D it-- C9►`[ A- t] a <br /> Address + 0 <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size Q <br /> 2 vt-� <br /> 1) x <br /> 4 TR 0-V <br /> T A Zw y� <br /> $ 1 ."Ou"l9 <br /> 12:LO X ?< <br /> li Jl Z, <br /> 10 T�i6 ! � �3•� <br /> 12Tg � <br /> 13 �,� X <br /> 14 T <br /> 15 <br /> 2 <br /> Sample Receipt-To Be Bled By Laboratory Relinquished by 1 Relmr ed by Relinquished by 3 <br /> Sampler F--.M C/ } <br /> Total Number of Containers f Properly Cooled Y/N/ A Signalur Signature Signature <br /> Custody Seals Y/N/NA Samples Intact N INA Printed Name Printed Name Printed Name <br /> 9 a P•r <br /> Received in Good Condition Y/N Samples Acceptef/N Dat -01-v 14 Time �p}^;W Date Time Date Time <br /> Turn Around Time <br /> ReceivedBy 4 1 Received By 2 Received By 3 <br /> Signatur� s�Z Signature Signature <br /> �&ormal ❑ Rush Q Same Day ❑48 hrs Printed Name Printed 19m a �_ / Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Dat Time Date �� Time � Date Time <br /> n-drih,dinn whirs 1 nhnratnm canary tahnrafom Pink-Proiect/Account Manager Goldenrod Samplerioriginator <br />