Laserfiche WebLink
4 <br /> ASSOCIATED LABORATOR LA\ <br />' 806 North Batavia ■ Orange CA 92868 <br /> 6 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> Company ,11l�f f 01 L Pho 6G q21— 3,� o A L Job No Vs 6110 Page of <br /> Project Manager I� 7 <br /> E rF �� }� 5 Um 4ax 12,{Y 7IAnalyses Requested Test Instructions&Comments <br /> s Project Name /r + I , Cy Project 4 f <br /> Site Name fCSL 1W G /�] J✓! Q C/ <br /> and l 2 5-v <br />' Address <br /> S�Ioclzw�-/ CAY6-2.06-' <br /> Container r 1� <br /> Sample ID Lab ID Date Time Matrix Pres <br /> Number/Size l <br /> u TB w 5Vo,+ NCL- Fn <br /> 3 T6 J0 /6 X L G'MF'C7f1l�tJ J (� l f� <br /> F 4 �� l 15 '14 cad . �1 rr< <br /> 4 <br /> s Kw(, wl-o X / ���fRr�t�L <br /> MVu-SP, L FTi1��Ncl� <br /> s H U.r lj 16 t toX XX <br /> tt (� r 1 �' <br /> i <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sample Receipt -To Be Filled By Laboratory Sampler <br /> Total Number of Containers ly Properly Cooled Y/N/NA Signature y q Signature Signature <br /> Custod Seals Y 1 N/NA Samples Intact Y/N/NA Printed Name �j Printed Name Printed Name <br /> y J^�)q'1-FL> F;l CU <br /> Received in Good Condition Y/N Samples Accepted Y/N Date ` v t,O Time IC, Date Time Date Time <br /> Turn Around TimeReceived By 1 Received By 2 Re=ed By 3 <br /> Fi�AFK <br /> Signature Signature Signature <br /> a <br /> 1�-hormai ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed Name Printed Name <br /> ❑24 hrs ❑72 hrs V <br /> Date Time Date TimeD t� Time <br /> Distribution White-Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Samplerl0ngmator <br />