Laserfiche WebLink
AMCMELVINU <br /> 806 North Batavia ■ Orange, CA 9286 <br /> Chain Custody Record Phone (714) 77I-6900 • Fax (714) 538- 209 <br /> Compan Phone <br /> A L Job No B Page Q- of <br /> Protect Manager 1\/\'.VZ Fax rt 1 <br /> 0 Analysis Requested Test Instructions& Comments <br /> I <br /> Protect Name 1 s7 Protect q <br /> Site Name <br /> and <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> S <br /> 9 <br /> 1Q <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Rahnqulshed by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N/NA SI Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Pnn _ Printed Name Printed Name <br /> Received in Good Condition Y!N Samples Accepted Y/N DateADa' Ti rnI Y, Date Time Date Time <br /> Turn Around Time a lv yIt Received By 2 Received By 3 <br /> Signature Signature Signature <br /> Norma! ❑ Rush D Same Day ❑48 hrs Prinled Nance Printed Na Printed Name <br /> ❑24 hrs ❑72 hrsD ra VV <br /> Date Time Date Time Date Time <br /> Rlatnbubon White Laboratory Canary Laboratory Mink Project/Account Manager Goldenrod-Sompler/Origlnator f o 0 <br /> I <br />