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i <br /> ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange dA 92868 m\ <br /> Chain of Custody Record Phone (714) 771-6900 = Fax (714) 538-1209 <br /> Company - $2 "C.- C.0- • A t Job No W O-L Page of <br /> Project Manager er--r �URYAgQ,5uml <br /> Fax qy�.Q'Jv <br /> AnalY 51s Requested Test Instructions 8 Comments <br /> Project Name r N t C� 1/4' ,Project N /V <br /> Site <br /> and Name 12 -C) 1.�.�/ I L s 0 4 � _P3 � � <br /> Address s�C9FDt,1 CA � 65-2-06- � j e <br /> Sample ID Lab ID Date Time Matrix Container Pres �6p x�0 12 <br /> Number/Size x <br /> 3Vo Nf L X �5 iJ2� <br /> 2 K f V- nlc cif rw 17r� <br /> 3 Tf,� Vo UH Poore bS V 3 Fb <br /> 5 Kw G b ,Z X X f5P� MW-WOO $ZCv <br /> 2 •�Yv >G <br /> 7 <br /> e <br /> I 2.V o f`ti7�F- <br /> t <br /> 12 <br /> 13 <br /> t� ams <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Rellnqut%1 by _,4_." Relinquished by 3 <br /> Sam ler CL� <br /> Total Number of Containers Properly Coolejo N/NA Signature Signature Signature <br /> Custody Seals YNA Samples fnta /NA Printed Name Printed Name Printed Name <br /> Received in Good Condibo N Samples Accept;6) <br /> Y N Date Time 17-1 Date Tlme Date Time <br /> Turn Around Time Rece ed B 1 Received By 2 Received By 3 <br /> dNormal <br /> Svgnature 5vgnalure Svgnature <br /> L] Rush U Same Day 0 48 hrs Printed Name Printed Name Tw1 �-u\A) Printed Name <br /> 0 24 hrs ©72 hrs <br /> Date Time Date t 5 TimeDate Time <br /> O <br /> ' Distribution White Laboratory Canary-Laboratory Pink Project/Account Manager Goldenrod Sampler/originator ��. 7 4 �' t� <br />