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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Oramge, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 , Fax (714) 538-1209 <br /> CompanyZMT+(L/--7( 1 <br /> r"� o t L C`. Phon Z Q 2-.t-3 6'3/ A i_ Job No � 1 32-8 <br /> Page--X—of C( <br /> Project Manager 4 Fax J '1 <br /> ��� ��SU`,gl� �'� �2,(-- ,�(� Analysis Requested Test instructions&Comments <br /> Project Name V , Projbct# f r/� <br /> Site and Name rt �C) r T t� �tO V 4Voy�L, <br /> Address <br /> Container I <br /> Sample ID Lab ID Date Time Matrix Number/Size ties cv <br /> Q <br /> 2 ; A X Fop- oX �� <br /> Wo� COM OU463 iN <br /> 5 '713 <br /> s LU- 2 16 '3o X x >C x <br /> ' •M W— JR 16 ,3 oc- <br /> s �< ?< <br /> MTzF <br /> 11 <br /> c} i P 1v <br /> 13 r 4- <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished ter C 1 Relin pyo, ST� Relinquished by 3 <br /> pler <br /> Total Number of Containers Property Cooled Y/N/NA Signal 0— -v -,» S4gnattur�e�ovr=,n�r 0 aw Signature <br /> Custody Seats Y/N/NA Samples Intact Y/N/NA Pnnt��am� �fv��- Printed Name �F Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date �r /_ Time Date Time Date Time <br /> Turn Around Time Recey y� { �4 Re Yea ey 2 Received By 3 <br /> Signature (r'"r-� ,oi�� Signature Signature <br /> 11(lNorma Rush 0 Same Day ❑48 hrs Printed Name Printed N me Printed Name <br /> ©24 hrs ❑72 hrs -1� <br /> Date Time Date S Time u Date �� e <br /> 1 <br />