Laserfiche WebLink
• ASSOCIATED LABORATORIF -, <br /> 806 North &rtmnc ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fcnr (714) 538-1209 <br /> Company � � /'c- � * Pho / � � A 1 Job No �( 9- Page /[ of <br /> Project Manager .�� �� Mi Fax s,1ry� IW,� Analysts Requested Test Instructions&Comments <br /> Project Name !Sj _ p s !`r Proj p L d'� <br /> Site Name tt 6^yl� <br /> and <br /> LJv � -pwt�[ 16Z4.)6 � <br /> Address ' ClL1rDt4 ! ? � <br /> r <br /> F� <br /> L fl' <br /> Sample ED Lab ED Date Time Matrix x Pres <br /> Number/Size E'1 <br /> ' W 00 4 O 0A 0a, XX X &is P is <br /> 2 �t LV 16,40 A r-02. o9 "rte <br /> 3 15'a )< COKP,014�!L vsoca iH <br /> 5 p�> to 15.E $2&o il, <br /> a <br /> —1 R> 'I-- 15'3 ?� X xM�V7 4t4c,4- <br /> r J 'L 27T1 <br /> „ it FME- <br /> 12 Y 'f`��✓� <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By laboratory Relinquished h� ( , Rehnquis d b� Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Properly Cooled Y/N/NA Signatu y�}� Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Pnnt amg Printed Name Printed Name <br /> ff��1�3i <br /> Received in Good Condition Y/N Samples Accepted Y/N Dat �� �� O j Time !�r f 1 _ Date ime ate Time <br /> Turn Around Time Re ae�ed� �{ f 1'(7v Recefv d By z � eived sy s <br /> ,_,.�JJ Signature Signature Signature <br /> [�, Normal ❑ Rush 0 Same Day :148 hrs Printed Name Pnnt a e ! Printed Name <br /> ❑24 hrs Ll 72 hrs I <br /> Date Time Dat t Time )a Z� Date Ti e <br /> C Z.. <br /> Distnbution White Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod Sampler/Originator <br />