Laserfiche WebLink
ASSOCIATED LABORATORIES <br /> 806 North Batavic t - Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company l ` �„ n Pho j Ja� "3 j�d A L Job No q 7 ` q Page of <br /> Project Manager �y f Fax �U !C?a t/ �[ [ `Analysts Requested Test Instructions&Comments <br /> Project Name Prot t <br /> Pt 04T lei \ �G( t' f <br /> Site Name <br /> and <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time Matrix Humber/Size Pres <br /> 1 <br /> 3 q ; x <br /> 4 0: <br /> 5 —,BZW 10,24 2< X X <br /> s 10 s� <br /> — � V AO:4 <br /> ----�f`v <br /> 10 LL/ i X X r <br /> 6*4 <br /> T-3 <br /> ,4 <br /> 1512 by 1 Relinquished by 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler <br /> Si nature Signature � :r Signature <br /> Total Number of Containers Properly Cooled Y!N/NA g OLIO;R 4 t t�'t"F <br /> Printed Na a Printed Name Printed Name <br /> Custody Seals Y I N I NA Samples Intact Y I N/NA f Q, v' C+< <br /> Date Time t Date Time Date Time <br /> Received in Good Condition Y/N Samples Accepted Y IN fir_ - <br /> Reae ed t3y Re erved By 3 <br /> 1 Retery y <br /> Turn Around Time j_01%ew �&54- <br /> Si n Signature <br /> &54- <br /> Signature U'c �~t f'G r+T 9 <br /> ©Same Day 0 48 hrs Printed Name �T7 Pnn N 2 Printed Name <br /> 8� ❑ RUS�1 Q 24 hrs ❑T2 hrs t r <br /> Time Date Time <br /> Time Dater � � '�-J <br />