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ASSOCIATED LABORATORIES <br /> 806 North Batavia • Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> A L Job No G� <br /> CompanyQ/ , ©r W L �^� P �Jbc� �Ci7:JQ'� � <br /> ` Page of <br /> Protect Manager � � Fa ry /�'�+c'[�o Analysts Requested Test Instructions&Comments <br /> Project Name �- ' I, Prof t# ttJiJ <br /> Site Name <br /> and <br /> Address <br /> Sample ID Lab ID Date Time Matrix ContainerPres �•! <br /> Number/Size <br /> ' `ted 09 15'. 0/ 4 '20 0 3 VO4 t4a ,P��rJi <br /> 2 <br /> 1612 ' fofL �'r <br /> 3 RW <br /> U59b 1 N <br /> 4 M to K X )C <br /> 6uj3 'S X >C l�tF��oCr <br /> I-;w �to <br /> r`-P we,, 6 ,2474 2.voi- F4Gl, S QISG <br /> 12 <br /> 13 vV� U J <br /> 14 tJ <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquish F%JF 2 Relinquished by a <br /> Sam ler <br /> Total Number of Containers IS Properly Cooled Y/N!NA Signature Signature Signature <br /> Custody Seals Y/N 1 NA Samples Intact Y 1 N/NA Panted"% <br /> " p1 wai'4, Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date V� V f Time )6,_,V Date Time Date Time <br /> Turn Around Time Received B 1 Received 8y 2 Received sy /7 )'s, <br /> Signature Signature Signature <br /> Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed Name Printed Name <br /> U 2 hrs El 72 hrs VONb VU <br /> 0 - - - - - Rr . F) 1-7 Date Time Date Time Date e <br /> 11 CT <br />