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• ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orange CA 92868 LA\-- <br /> Chain of Custody Record Phone (714) 77I-6900 x Fcar (714) 538 2209 <br /> Company '�0=-e—14 L` t [=L7 Phone Y7 '3 � ` e `3 r A L Job No 1 s �' � t� Page of <br /> Protect Manager Fax ` s Analysis Requested Test Instructions& +Comments <br /> Project Name St Protect# <br /> Site Name <br /> and � <br /> yr ( ! _f <br /> �Z�j � Iii./ � !tel — (� Y 1 <br /> Address 6 <br /> �270,5- <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size <br /> Container <br /> Pies l � <br /> - U vi `40 ' 0Y, L4JkP3evfr i3 � <br /> a 'of _ ` -K <br /> 8 <br /> B t Z1 <br /> 16 -06 I i Jr <br /> i0 I <br /> r <br /> (5 w <br /> r Relinquished 1 Relrn?11isthIeld biy� Relinquished by <br /> Sample Receipt-To Be idled B Laboratory Sam ler 7F � i4 3 <br /> As <br /> Total Number of Contamers Properly Cooled Y!NINA 5ignatur y {r Signature ,)V,- Signature <br /> Printed Na"0 Printed Name �f Printed Name <br /> Custody Seals Y I N I NA Samples Intact Y I N/NAS <br /> Dat Time �_ Date s e Rate Time <br /> Received in Good Condition Y/N Samples Accepted Y/N rr�%' ,t✓ <br /> Turn Around Time Received By r- 1 Rec 1ved ceived By 3 <br /> G uLa,�rs? #Yt <br /> Signature I t= _ Signaiu Signature <br /> ❑Same Day ❑48 hrs Printed Name Pn ted e r' Printed Name <br /> NormaE Rush ❑24 hrs 0172 hrs <br /> piste Time bat � line Date Time <br /> �� <br /> Nstributton While Laboratory Canary Laboratory Pink ProiectlAccount Manager Goldenrod Sampler/Originator .....-.. <br />