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i ASSOCIATED LABORATORI <br /> 806 North Batavia a Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 a F c (714) 538.1209 <br /> Company VVI l C1/ L ctL iP1e:c1:#76 c/ 1 L l <br /> A t< Job No <br /> Protect Manag r1- �r Page of <br /> 12V5V1-wv ��{-- 5�� Analysts Requested Test Instructions&Comments <br /> Protect Name <br /> Site Namei <br /> and <br /> Address <br /> P # <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size <br /> F �-[1 r ©,�.� . ter � � Ld ,,1 � x <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> b <br /> 8 <br /> 9 <br /> 10 <br /> 71 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory sam qshed b' a�r9�F 7 Rehnqu�d�b� 2 Relinquished by 3 <br /> ler <br /> Total Number of Containers Properly Cooled Y/N/NA 5ignat i Signature Signature <br /> Custody Seats Y/N I NA Samples Intact Y/N/NA Printed gNS Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y IN D1 A 1, 0 ft Time )l P Date Time Date Time <br /> Turn Around Time ReceiWd By Received By 2 Received By 3 <br /> � // Signature Signature Signature <br /> l�J'Normal Ll Rush 0 Same Day ❑48 hrs pnn Printed Name Printed Name <br /> ❑24 hrs 0 72 hrs <br /> Date Time z5 Date Time Date Time <br /> Orstnbution White-Labotntory Canary laboratory Pink ProlecVACCount Manacter Goldenrod Sampler/Originator <br />