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I <br /> AssocrATED �so�xTo�r� • <br /> 806 North Batavia ■ Orange, CA 42868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (714) 538-I209 ' <br /> Company <br /> '2 —3 A L Job No �} 1 C Page of,^ <br /> Project Manager <br /> — �� Anal Requested Test Instructions&Comments <br /> FF UR. �IlM d Analysis <br /> Project Name l P lett# <br /> Site Name <br /> and 126Z) Alt W t�iS01-/ WkV <br /> Address <br /> Sample ID tab ID Date Time Matrix ContainerPres <br /> Number/Size <br /> Q r <br /> oza 10..k <br /> 2 C <br /> 3 T$ 9w o•6 <br /> a T$ V <br /> .00 <br /> 6 11-2o <br /> 7 M WIW <br /> $ ��-M.12- <br /> /yf� Iv <br /> //{ 1� a/��j}��] <br /> 10 'I Z'00 <br /> 11 <br /> +1 �(! 12 to <br /> 72 gip 1,� � J C:"20 <br /> 13 Mw6- .12 <br /> 141 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished FX 2. Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Property Cooled Y/N/NA Signatu Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed me Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time Date Time Date Time <br /> Turn Around Time Received 1 Received By 2 Received By 3 <br /> Signature SignatureSignature <br /> f Normal ❑ Rush ❑Same Day ❑48 hrs Printed Name Printed Nfime <br /> DT,)G -JJ Printed Name <br /> ❑24 hrs ❑72 hrs01) <br /> Date Time pate Time Data lime <br /> Distribud+on White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />