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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 o Fax (714) 538-1209 <br /> Cnmpany7 J7 Q Lei (L7 _ [3' Phon(6-6 2— q V 53�1I �. ! J 9 <br /> A L Job No Pae of <br /> Protect Manager Fax 1 y �� Analysts Requested Test Instructions&Comments <br /> Project Name <br /> Projecl# <br /> Site Name <br /> and 2. 0 UQ 1't- 5 C) w r� E <br /> Address � L �� C f� 2 C <br /> I t � <br /> Sample 1D Lab ID Date Time Matrix Container Pres n �y <br /> Number/Size <br /> 3 <br /> I <br /> 4 <br /> r � <br /> 5 <br /> r � <br /> 7 <br /> r <br /> 10 <br /> 11 <br /> r' <br /> 13 <br /> 14 <br /> 75 � <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Aelrngwshed b _r 2 Relinquished by 3 <br /> Sampler f" f' C Cv� t f �7 <br /> Total Number of Containers Properly Cooled Y 1 N I A! Signa u ` Signature — Signature <br /> CustodySeals Y I N/NA Samples Inia N/NA Prrnte Nam Printed Name Printed Name <br /> p F_d, , ? lr`= t <br /> Received in Good Condition Y I N Samples Accepte Y/N Da� Time ` Date Time D rte Time <br /> Turn Around Time RecM$yt J,(R? Received By 2 Received By 3 <br /> Signature L 7 Signature Signature <br /> Normal ❑ Rush D Same Day U 48 hrs Printed Name Printed NaPnnted Name <br /> 1324 hrs G 72 hrs 1�G V\-J <br /> Date Time Date Time Date ime <br /> 16 AM <br /> Distribution W11111kaboratory Canary Laboratory Pink ProlectlAccount Manager Goldenrod Sampier/Originator <br />