Laserfiche WebLink
806 North Bat=a a Orange, CA 92868 <br /> Cham *custody Record . Phone (714) 771-6900 • Fax (714) 538-;i <br /> company C` � <br /> ` LO, Phone ��� 1 A L Job No j 0 i Page of <br /> r� <br /> Project Manager,A It � � Fax _ 5 161 Analysis Requested Test instructions& Comments <br /> Project Na ,�V \ 1 Protect""' co <br /> Site Name <br /> and <br /> Address + CA <br /> \� Q_ <br /> 1 r � <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 1VJS$' 416105 <br /> 2 5 -ay 65 5"'D 8 ' _016 s H�- <br /> 3 <br /> 4 <br /> 5 <br /> B <br /> 7 <br /> 8 <br /> s <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By story Relinquished by u r 1 Relinquished by 2 Relinquished by 3 <br /> Sampler_ <br /> Total Number of Containers Properly Coolk A/NA Signatur Signature Signature <br /> Custody Seals Y IN A Samples lnt t N/NA Pnnt Name �y Printed Name Panted Name <br /> Received in Good Condi on N Samples Accept N Date � p,� Time ,6 Date Time Date Time <br /> tJ 1 f <br /> -� Turn Around Time Received By IV Received By 2 Received By 3 <br /> / Signatur Signature Signature <br /> XNormal ❑ Rush U Same Day ❑Q his Panted Na Printed Name Printed Name j <br /> ❑24 hrs ❑72 hrs <br /> Date D Time Q Date Time Date Time <br /> J <br /> D+stauLon—White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Samplar/Originator <br />