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• ASSOCIATED LABORATORV LA <br /> 806 North Batavia ■ Orange, CA 92868 <br /> Chain of Custody Record Phone (7I4) 771-6900 Four (714) 538-1204 <br /> T <br /> ' CompanyPhon �J <br /> MP � o r L � �6 12-� "�� � A L Job No � � 7 l Page of <br /> Project Manager Fax yt <br /> r r'JJ Analysts Requested Test Instructions&Comments <br /> Project Name �� . Prolec a'74 <br /> r <br /> and Name <br /> f D P,n+ n, <br /> ff�� Ff]�j LU <br /> Address � 1 CY{+}� C---/zt- !J 6-20jr� OCT 2 4 X003 <br /> Sample ID Lab ID Date Time Matrix Container Pros c1 ENV1 �! � r <br /> Number/Size PERMIT/SEE- iCES <br /> V",�. %,v? 43 DC7 a NL x <br /> 2 t't�FLt1�N' <br /> 01. tc awe 13 20 12 <br /> 3 <br /> 4 <br /> 5 <br /> s <br /> -ell <br /> t3 ' <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> t5 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by y � 1 Relinquished Relinquished by 3 <br /> Samplercy <br /> Tota!Number o!Containers Property Cooled Y/N/N S+gnatur Stgnaturet9 Fr �i��} l Signature <br /> V Y <br /> Custody Seal Y N/NA, Samples Int Y/N/NA Panted Name ,14 au, Printed Name Panted Name <br /> Received In Good Condition Y/N Samples Accepted`Y}/N Dat 0,�19 0 Time /y* Date Time Date Time <br /> Turn Around Time v ReCe ed s J r 1 Received By 2 Received By 3 <br /> a�L : <br /> �/ <br /> Signature ovae L 1)r� `9;41N <br /> Signature <br /> �7 Normaf ❑ RUS�1 Same Day ❑48 his Panted Name !`l Jr Printed Name <br /> ❑24 hrs 0 72 hrs <br /> Date Time D Ti ! t) Date Time <br /> thstnbution While Laboratory Canary Laboratory Pink Protect/Account Manager Goldenrod Sampler/Onginator (� <br />