Laserfiche WebLink
- ASSOCIATED LABORATORI " LA <br /> ( 806 North Batavia • Orange, CA 928158 <br /> 6 <br /> Chain of Custody Record Phone (714) 771-6900 a Fax (714) 538-1209 <br /> Company r�Q}L� 0rL C Ph J5 1z�� 55 �1 AL Job No Page of <br /> Prolan Manager rrCC! � ��v 5 vy��� F i Analysis Requested Test Instructions&Comments <br /> Project Name kpo p nr .�! Project N I� <br /> and Name <br /> 2 f "tj �vl C�' <br /> Address M-0c�! v(� L L�– r IT- { <br /> (( VV <br /> Sample ID Lab ID Date Time Matrix Container Fres r, r X <br /> Number/Size t-T <br /> 2 [N r A $ irO WPOP <br /> U12. 9 :Alo wpoi2 JC <br /> 7B12V 9 :SaVWP- <br /> 5 b 12 W/ to,K, <br /> VivD+p- <br /> ' 7E) v Attu <br /> • e i6� w f �� � X <br /> I til V VMP, <br /> 10'-rib 11 w 12_''o VOW, <br /> 11 , <br /> XV9Png <br /> 13-16b 1 i5v ONO- �C <br /> ,4 <br /> 15 <br /> Sample Receipt-To Be Filler!By Laboratory Rehnqurshed by 1 Relinquished by `� 2 Relmqurs 3 <br /> sampler <br /> Total Number of Containers Property Cooled Y/N/NA Signature A ' Signature Signatu <br /> Custody Seals Y/N/NAS Samples Intact Y/N/NA Ub i Pnnted Name �12A L „ Pnnted Name Pnnt ame r� <br /> J�✓ Uj v}- r f <br /> Received in Good Condition Y/N y&I) 5amples Accepted Y/N p S Date as Time Date Time Date 2 1 Time <br /> of <br /> Turn Around Time Received By 1 Recerve 2 Received By 3 <br /> Signature Signatu Signature <br /> �lormal ❑ Rush ❑Same Day ❑48 hrs Pnnted Name Fc A Pnnted ame Printed Nam <br /> ❑24 hrs E)72 hrs 'n J <br /> Date Time Date <br /> L'9-G 1 Time Date <br /> �l r <br /> Distribution White-Laboratory canary-Laboratory Pink-ProjeWAcr ou+t Manager Goldenrod-Sampler/originator <br />