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ASSOCIATED L UORATORIS <br /> f 806 North Batavia ■ Orcmge, CA 92868 <br /> Chain of Custody Record C Phone (714) 771-6900 ■ Fax (714) 538-1209 <br /> CompanyIf D ( � Ci) Phon � �V A L Job No Page of <br /> Project Manager r /� Lt,� h Fax 7 •4 Q Analysis Requested Test Instructions&Comments <br /> Project Name Project <br /> Site Name <br /> and 25-0 f l r f 1,-3..,D„ / L��1dJ I <br /> W f}L't'�/ <br /> Address ff D Ti,2 O f c <br /> ,44 <br /> Sample ID Lab ID Date Time Matrix Container Pres f� <br /> Number/Size <br /> i O 313 v 9 �o wo 'QC- 'SIA >C . <br /> i b6T6 9 -61 A <br /> _�� to 116 <br /> 11 .n <br /> T P) <br /> 0 U .-' 'o <br /> 10 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished by 1 Reftngw heZ by 2 Relm 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler -Ck, <br /> Total Number of Containers Properly Cooled Y I N/NA [ter Signature Signature Signa <br /> 7� c <br /> Custody Seals Y/N/NA P f0 Samples Intact Y/N/NA Panted Name Panted Name Pn ed Name <br /> Date Time Date Tlme Date jI Time <br /> Received in Good Condition Y/N �l?s Samples Accepted Y/N �` p �� 3rly-o <br /> Turn Around Time Received By -C' 1 Receiv y 2 Received By r <br /> Signature rPn—nI1,gnal Signature <br /> lNormal RUSK U Same Day U48 hrs Panted Name d Nai M J Panted Name <br /> Q2 hrs J7 hrs <br /> Date Time Date Time [455 Date Time <br /> Distribution White Laboratory Canary-Laboratory Pink Project/Account Manager Goldenrod Sampler/ongmator `c I <br />