Laserfiche WebLink
ASSOCIATED LABORATORIA LA, <br /> 806 North Batavia ■ Orange CA 92868 <br /> Phone (714) 77I 6900 Fax (714) 538 1209 <br /> Chain of Custody Record <br /> Company PhonV C40. SG2 �}z,1^'3 CU/ A L Job No �v �! Page of <br /> Pronager Fax 5�2 'Y9 Analysis Requested Test Instructions 8 Comments <br /> tect ma <br /> Protect Name � 4� ��, <br /> and �.>����Gxf Prot t� I�jr/ v <br /> Site Name 12-60 W/1-:50/�c w <br />� r <br /> Address :57V / t <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size x <br /> ©2 00 A(PP, /I TER W, Wo NE X X <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 4 � <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinqhed by 1 Relinquished by 2 Relinquished by 9 <br /> uis <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> Signature Total Number of Containers Property Cooled Y/N/NA <br /> Signature Signature <br /> Printed Na r Printed Name Printed Name <br /> Custody Seals Y!N/NA Samples Intact Y/N/NA ` �-ow <br /> Samples Accepted Y/N Date Time Date Time Date Time <br /> Received in Good Condition Y/N 0�, 02-- 18 ,490 <br /> Received By�.h� 1 Received By 2 Received By 3 <br /> Turn Around Time r�� <br /> Signature Signature Signature { <br /> ❑Same Day El 48 hrs Pnnted Name Pnnted Name ��V -� Printed Name 11 <br /> Normal LlRush El24 hm ❑72 hrs <br /> Date Time Date Time Hate Time <br /> r r —n Whdo 1 lhrr-dnry ihnrff— Pm4 PrniRri/Arr,int Mttnq-r fnirl—n.t S�mnlnrlr}rlal^+f nr <br />