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ASSOCIATED LABORATORIES LA\ <br /> 806 North Batavia - Orange CA 92868 <br /> Chain of tustody Record Phone (714) 771-6900 ■ Fax (714) 538-1204 <br /> Companya r p 1 T Phon !-3 6/ A L Job No (� 3 Page of <br /> Project Manager Fax `%1[s j P]�( rf <br /> 66 q2,1 r ,X-� Analysts Requested Test Instructions & Comments <br /> Project Name l h1i n`T {F cr M�1� � iC,r Proj # a/ <br /> Site <br /> and Name ).0 60 V�1L?� W Y <br /> Address �'g�,G��f� C 6^fi! J 2��'-• „� /` <br /> Container <br /> Sample ID Lab ID Date Time Matrix Pres �-- � <br /> Number/Size <br /> 2 1 N tWr-- 06, 1 1_v'�> fl l 4 1P— gr—ow t4eattr-i ?C x <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> B <br /> 9 <br /> 10 <br /> I <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by1 Ralrn casheded b� Relinquished by 3 <br /> Sampler <br /> Total Number of Containers Property Cooled Y/N/NA Signatu Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N Date Time j Date Time pate Time <br /> Turn Around Time Recent, RecetoQfy 2 Received By 3 <br /> Signature 5ignatur Signature <br /> Normal ❑ Rush ©Same Day ❑48 hrs Printed Name Pr N e Printed Name©24 hrs LI72 hrsDate Time Time �t�a Date Time <br /> Dlstnbutiom Wtute-Laboratory Canary-Laboratory Pude Project/Account Manager Goldenrod Sampler/Originator <br />