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ASSOCIATED LABORATORIES <br /> 806 North Batcma ■ 01cin9e CA 92868 <br /> Chain of Custody Record Phone (�1�) 771-6900 = F� (714) 638-1209 <br /> Company �Q , I� � � `. ph o Z �?�2- �6-2� � A L Job No Page of <br /> Protect Manager 1� [� �M F /G f3` r'� �{ Analysis R quested Test Instructions&Comments <br /> Project# <br /> Protect Name QL LU <br /> Site Name <br /> and '770,60 17-V O)'S 2 <br /> Address <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres <br /> �C X Cori POO n14)3 U s� tM <br /> 4 r (:4. 0-4-30 r-r 4CE d <br /> . �� — X <br /> Lo 21,60rvt , <br /> t3� <br /> Kw -�� X <br /> 12 ✓� r^� <br /> 13 � <br /> 14 <br /> 15 <br /> Relinquished b 1 Relinq het,h 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory sam ler <br /> Srgnat Signature _ t Signature <br /> Total Number of Containers J b Property Coole N/NA Do> <br /> Printed �r� Pnnted Name Printed Name <br /> 11 Custod Seals Y Nr1 NA Samples Intact N/NAA^�, Fr rr+�c+'V <br /> I, Time <br /> Dat � rr Time , Date Time Date <br /> Received m Good Condi on N Samples Accept N �t r b� 1 <br /> Re ry d By i Received By 2 Received By 3 <br /> Turn Around Time -Zlrk_t <br /> Signature G' W <br /> Signature � Signature <br /> 0 )ra t l - <br /> ❑Same Day ❑48 hr �} <br /> s Printed Name Printed Name Wim'C3 <br /> Name <br /> �N <br /> Ormal ❑ Rush ti�v c <br /> C3 24 hrs ❑72 hrs Time Date Time Time <br /> Dat r C r . 4 <br /> w....-.. ..w—i— Pink Prowl-VAccount Manatier Goldenrod Sampler/Originator 1 <br />