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ASSOCIATED LABORATORIES LA <br /> 806 North Batavia • Orange, CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 Fax (714) 538-1209 <br /> Company,r74/�, O!� C�, Phone J6.`[ry^ . V-3 V 8 A L Job No 13 q 59 3 Page of <br /> Protect Manager fax - L� <br /> 32,(_1_5 (AQ Analysis Requested Test Instructions S Comments <br /> Protect Name � � r� Project k <br /> and <br /> Address �` 4Q <br /> �5TVC49f M14 95206_ <br /> Container (50 <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres (J c•i ca <br /> tzo 00 C>a <br /> W`L a o -E7k )012 iZ <br /> 2 1 V <br /> 0 <br /> 5 T — IV !a kv <br /> 8 rs — 9 w* �J . ZO X X <br /> +n � -r� s <br /> 10 — 59 X X <br /> to M vJ -5 � <br /> 196 T6LI t+z;�o x <br /> 11 <br /> 12 oo +0 <br /> 13 <br /> 10 10 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by Relinquished by 3 <br /> Sampler F {vrt <br /> Total Number of Containers Properly Cooled Y/N/NA Signalur Signature o u �� Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time Date Time Date Time <br /> Turn Around Time Received By 1 Received By 2 Received By 3 <br /> h� <br /> Signatures Signature Signature <br /> Normal ❑ Rush ©Same Day ❑48 hrs printed Name Printed NamePrinted Name <br /> U 24 hrs ❑72 hrs �� �J <br /> Date Time Date $ 1-7 Time t+,J Date <br /> q t <br /> OisMbutlan Whit* Lahomf— C'*n*ry 1 whnrvinry Pink Prn1­f/A,,n—1*4­­ <br /> I'n�.twrwnA C�mn�nr/n s..i...a.. <br />