Laserfiche WebLink
ASSOCIATED LABORATORIES <br /> 806 North Bataina + Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714)538-1209 <br /> Company IPhon ��72 �A �� -84 A 1 3 52o ?age of L Jab No <br /> Protect Manager Fax <br /> r �Ur� (CU5 ivmffi 56 2 Analysts Requested Test Instructions&Comments <br /> Protect Name � �� Prot t# <br /> Site <br /> /' <br /> ' r'�t re'�c_.- <br /> and Name ZW <br /> 5 p r t- <br /> e i -So.,J WT1L <br /> Address <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size Q { <br /> 1— rs- 06-0T-C ( p Dw Int 6Z rTFrp L+ I�Of�� <br /> 2 P <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 I/ I <br /> 9 <br /> 10 <br /> I <br /> 11 <br /> 12 <br /> 13-- <br /> 14 <br />' 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished ayr f Re6nqu13heanY� Relinquished by s <br /> Sampler lc M e <br /> Total Number of Containers Properly Cooled Y!N/ A Signaiur C J` S,gnaiure,V;�0�p � Signature <br /> Custody Seals Y!N!NA Samples Iniac /NA Printe Panted Name Printed Name <br /> Received in Good Condition Y!N Samples Accept<Y/N Date/_ Time ary�+� Date Time Date Time <br /> Turn Around Time Received By T Received B 2 Received By 3 <br /> GA 1;0 cF y <br /> Signature VI; p, }�6_Rf Signature [Date <br /> ignature <br /> L)Same Day ❑48 hr5 PrintedName �t-� Printed Nam <br /> Normal ❑ RushDa2trinted Name <br /> ❑24 hrs ❑72 hrs O-Y. C. VV <br /> Date Time Date Time me <br /> Mbutr leLAW C a6ora nk P�counMer G� Sar_iginal I� ♦♦ <br />