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• ` ASSOCIATED LABORATO r . <br /> J �] 806 North Batavia • Orange CA 928b8 <br /> Chain of Custody Record l Phone (714) 771-6900 ■ Fax (714) 538-2209147A& <br /> Company / Phan � <br /> /Q i E OIL 4!!:L9L� 3W C. V i/ 36 Y A L Job No Page of <br /> Project Manager � ���U�� P Y 4 <br /> l�J Anal sls Requested Test Instructions&Comments <br /> Project Name �I}} t� �"]� .^) tq^w f1) / r //+ Project# /If Q <br /> aSite nd Name l4 5 �/ N l�l.j ! jL 5 T©'L�— ly CfCV/17V <br /> r l� ! >�J ; rl t� <br /> Address VvP r I <br /> Container ✓g <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres 14 <br /> v <br /> '11 <br /> 41 Q 07 4r-' a , J1- 0( 9 ' V*� �! B� � <br /> 1:coo 4 XXX <br /> 3 Te) a v ��. <br /> 4 r e) I2 UJ, Jo'zo )C <br /> Iv:S <br /> �g 9 LV . 11; 20 <br /> e <br /> 166 , 4 2: <br /> g tp-) J 2 X <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by Z Relinquished 3 <br /> Sam ler <br /> Total Number of Containers Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Panted Name,,56 � Panted Name Pnnted ,,. <br /> Nam k <br /> 1� � <br /> Received in Good Condition Y/N ' Samples Accepted Y/N Date l f') Time Gate Time Date („",_,1-C l Time <br /> Turn Around Time Received By Fe 1-Pk Received By 2 Received By 3 <br /> ,..�// Signature Signature Signature <br /> +�d`Normal ❑ Rush U Same Day ❑48 hrs Printed Name Panted Name �C Printed Name <br /> ❑24 hrs ❑72 hrs k�S <br /> Date Time Date k-1 efo\ Time Lp; Date Time <br /> Distnbution White-Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Samplar/Oriainator <br />