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ASSOCIATED LABORATORIES <br /> 806 North Batavia ■ Orange CA 92868 A\ <br /> Chain of Custody Record Phone (714) 771-6900 Fac (714)538-I209 <br /> Company Phane fj <br /> coo . 13Ca _a al 3S S A t_ Job No f[ Page of <br /> Protect ManagerFax <br /> S '156 - in PL4 V1 5 10 Analysis Requested Test Instructions&Comments <br /> Prosect Name ` ,. C.��Prolett q <br /> Site Name {� <br /> and hoc - 3 6D <br /> Address ,2-1R0Z) 9 2 S0 fQ <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> ra <br /> 7 <br /> S <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by ulC�1 Relmqutshed by 2 Relinquished by 3 <br /> t <br /> Sampler <br /> Total Number of Containers Fl Properly Cooled Y/N/NA Signature A. _ n_ gnature nature <br /> Custody Seals Y!N/NA lll4 Samples Intact Y!N/NA 1 anted amVei� �- CA Printed Name Prince Name 1 <br /> Received in Good Condition Y!N 1 Samples Accepted Y/N Q�tO�,o� u3 Time 2_ Dale Time Ti <br /> Date me <br /> —0 i <br /> Turn Around Time Recerved By 1 Received By eceived By 3 <br /> s Signature S nature ignature <br /> R <br /> ormal ❑ Rush U Same Day ❑48 hrs an�tedf�a_mprinted Name Printed Name <br /> El 24 hrs C�72 hrs V�- -f t3;— V, v c1 11� 0 <br /> rDate <br /> to 'Z,3 Ti ;L,3ro Date Time Date 11,0 10110 <br /> Distribution Whtte ratory Canary Laboratory Pink Protect/Account Manager Goldenrod Sampler/Originator - /sl <br />