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ASSOCIATED LABORATORIES LJ <br /> 806 North Batavia • Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714)538-1209 <br /> Company/ 0 L Phan �� yZ `� d^a/ A L Job No 0 Page of <br /> Project Manager Fax 4 !D f <br /> Analysis Requested Test instructions&Comments <br /> Project Name � Lf� A- <br /> Projec # / <br /> Site Name X50 h�CfZ7 f.U1 L' Lfl <br /> Address 4Q <br /> Sample ID Lab ID Date Time Matrix Container Pres 4. <br /> Number/Size (- -Q t <br /> 1 FrFEWFW -0-03 }"1e- � 4I- 404i;- x I k X <br /> 3 <br /> 4 <br /> 10 <br /> 5 <br /> fi <br /> 7 <br /> 718 <br /> 4 <br /> 10� <br /> 1i <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Rehnqurshed by n 1 Rebngwshed by 2 Relinquished by 3 <br /> sampler I <br /> Total Number of Containers Properly Cooler N/ } Signator !-f— Signature L)ZP—t 1[-wr Signature <br /> Custody Seals Y/N I NA Samples Int I /NA Printed Na a w�Z� Printed Name ,Panted Name <br /> Received in Good Condition Y/N Samples Accept Y/N Dat Z'�a Time /�, 1 _ Date Time Date Time <br /> Turn Around Time Recaed,9y pay„ 1 Received By 2 Received By 3 <br /> i+ (Jur <br /> Signatur��t�� fp�,�� Signature ignature <br /> �d Normal Rush CJ <br /> Same Day ©48 hrs Printed Name !`F Pnnted Name ��� Printed Name <br /> CJ24 hrs 0 72 hrs <br /> - Dat Time Date Time p>r Date Time <br /> '7. d <br /> Distribution WhW Laboratory Canary Laboratory Pink ProtecVAccount Manager Goldenrod Sampler/Originator <br />