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I <br /> ASSOCIATED LABORATORIES <br /> LA\ <br /> 806 North Batavia - Orcmge, CA 92868 <br /> Chain of Custody Record ����� Phone (714) 77I-6900 ■ Fax (714) 538-1209 <br /> t _ <br /> Company IJ f� i L `r Pho A L Job No Page of <br /> Protect Manager? Fax `/ G` Analysis Requested Test Instructions&Comments <br /> Protect Name 4 Project p <br /> Site Name n f { X <br /> t and �.0. W 1 09 �TT <br /> Address 3TVC4TV14f— t RJ ^ 'P F <br /> T <br /> Sample ID Lab ID Date Time Matrix Container Pres 14 <br /> Number/Size <br /> f�;4t wi Byl6t-s HCL S�� <br /> i <br /> Z m war t T,6 X �C X' ho <br /> Oft <br /> 3 <br /> 4 TBIO 13 raja X X[4 6 <br /> MwL <br /> M,w C 19, X ' 2 X771 A-t- o l— <br /> Mir <br /> 2V14`--n- 6 <br /> 12 - 7-lq <br /> 13 <br /> 14 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sampler <br /> ?Dial Number of Containers Properly Cooled Y/N/NA Signature ,ti Signature <br /> Signature <br /> 310 ( <br /> Custody Seals Y/N/NAffQ Samples Intact Y/N/NA Printed Name 3 � Printed Name Printed Name <br /> -7r_ <br /> I <br /> Received Time Date Time Date Time in Good Condition Y!N � Samples Accepted Y/N � <br /> Turn Around Time Received By 1 Received B Recrjm4 By 3 <br /> 6Q C <br /> Signature Sign un? Sign ure <br /> ©Same Day ❑48 hrs Printed Name Printed a Printed Name <br /> Normal Rush �� <br /> / ❑24 hrs ❑72 hrs <br /> Date 'w^ Time nt , Date s 22 <br /> � Time �f / Date <br /> � l <br /> Distnbution White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod-SamplerfOriginator <br />