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ASSOCIATEDLABDRATORIES <br /> 806 North Bcrtmna ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 ■ Bmc (714)538-1209 <br /> I <br /> Company n, ! ©t Ar, Pho 56q�S/ 36V A L Job No id Page of <br /> Project Manager{ n,, �rJ Fax (6-62-192.1-940 <br /> 62 792.1-940 Analysis Requested Test instrucElarts&Comments <br /> Project Name 0— ProiectSite A 1N <br /> Name <br /> and <br /> Address 5 r VW ro!`f <br /> Sample ID Lab ID Date Time Matrix Container Pres CL <br /> Number/Size �4 <br /> -24-off -P5oo 140 1- 0A 14 GL ?cSI p.. / A Fv <br /> 2 IFR--Ao —1,5:0 K Tc � ,�c G�rY>� Ca1KPflvIq 0 <br /> 3 AW- ro ��; 7S USS 114 G-1woiO " <br /> 4 Mw-4 ti ?� ?�C( �A-MgWivi, 8 260 <br /> 5 T�- I i 7< / <br /> s <br /> TVs 6�� ?C 7c X F7i-F ►q0 - <br /> - - <br /> 4 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Relinquished��by , 1 Relmgg�sh__e,d ppy Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler Tit�l [ [rol�3 � � <br /> Sk Signature t� Signature <br /> naur <br /> Total Number of Containers Property Cooled Y/N/NA g �-�" dUF pl a C7 <br /> Panted Name Panted Name Pnnled Name <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA <br /> Dat Time � Dais a flats Time <br /> Received in Good Condition Y/N Samples Accepted Y/N r2—L4-0.- ��•37/ <br /> Received By� 1 flet rued calved 9y 3 <br /> Turn Around Time C�i7ar-,'� Rrrf`r77 <br /> Signature DU p"4t f y Signature <br /> Signatu g <br /> L3Same day El hrs Printed Name I Pn t e I Printed Name <br /> Normal ❑ Rush ❑24 hrs ❑72 hrs <br /> p Time Da me 1 U`O� Date Time <br /> Distribution White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod Sampler/originator <br />