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ASSOCLAT£D LABORATORIES <br /> t (��� 8116 North Batavia it Orange CA 92868LA\ <br /> Chain of Custody Record Phone (7I4) 77I-6900 Fax724 <br /> ( ) 538-1209 <br /> I <br /> Company+TML L�( t �( (— � Phan A L Job No <br /> Page of <br /> Protect ManagerC6��� Fax K 2 Analysts Requested Test Instructions&Comments <br /> Protect Name � � T Protect# fIF� <br /> Site Name a <br /> and �'��j U1 1 L--iSO H WAY <br /> Address y62.o1� , oo 'foo �- <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size v— Cg - - <br /> w1? tvx GfZ9ffT " <br /> 3 C01OOrle;ls USW t <br /> 5 x x x F11 60 P <br /> �( I X k <br /> M w -3 P,' 1( 'Zu k X -Ito UG <br /> W — !, X <br /> to11 1 -llt�� <br /> ?� -IT 8 6- <br /> 12 <br /> t2 f , <br /> 13 , 6 <br /> r <br /> 15 <br /> l <br /> Sample Receipt-To Be Filled By Laboratory Relrnqurshed b 1 Rehngy, � J2 Relinquished by 3 <br /> Sam ler (r t`y <br /> Total Number of Containers Properly Cooled Y/N/NA Signa Signature 1!r� <br /> Punted Name Signature <br /> OvieuCustody Seals Y 1 N/NA Samples Intact Y/N/NA Parked N e r� <br /> �,� �� �� Panted Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date,_,? <br /> `(�T Time �'1 e Date ik—,,,.d <br /> Time <br /> Turn Around Time Received B 1 Received <br /> GvLa F�r-b' ,11,ol z <br /> Signature Sig ure r t❑Same Day U 48 hrs C?�'�xg!4rc-?y <br /> Normal ❑ Rush Printed Name Print a e 24 hrs ❑72 hrs <br /> 'I 1Aile <br /> Date Time Date me <br /> Obstributron Whrt storyCanary-Laboratory Pink Project/Account Martager Goldenrod Sampler/Originator <br />