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. ASSOCIATED LABORATORIES *PLM\ <br /> 806 North Batavia it Oronge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fox (714) 538 1209 <br /> Companr/—Y12 r—r 01 L Pho L 2 D2 A L Job No ,r Page of <br /> Protect Manager Fax u �/ a J �l <br /> AFF cl,� f�S[tM 6 Y21-15-10 Analysts Requested Test Instructions s Comments <br /> Project Name _ r y. F Prof # o f <br /> oo z`o f3 2 <br /> tom/ �j t f-[� <br /> Site Name <br /> and o <br /> Address 6-r <br /> 1� <br /> � <br /> Sample ID Lab ID Date Time Matnx [Vum Container tainere Pres X <br /> z LU- �t tt���t �C iip- on C-tlr/,?-r" <br /> 3 <br /> (24 <br /> 5 Jutw P- 14 ho n x x <br /> oc ?C zn g ill�Joi <br /> -X Ix IF—T�Fr�r-lac_ <br /> 9 - } '�h X K lit <br /> 1U � ,l 00 2VaA- 14 C1,- Z I Poe <br /> ,1 �' Fre <br /> tz <br /> 13 <br /> 14 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished 1 Relinquts d b t Relinquished by 3 <br /> Sampler t! F-11 �y�}r'? <br /> Total Number of Containers Property Cooled Y/N/NA SignaT� Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Pnnted Name Pnnted Name <br /> Received In Good Condition Y!N Samples Accepted Y/N Dat.Z q. Time , riso Date Time P Date Time <br /> Turn Around Time RecehjBred T `tq .mit Recehr y 2 Received By 3 <br /> Signature (tet i� Signature Signature <br /> Normal ❑ Rush 0 Same Day ❑48 hrs Pnnted NamePn t N Printed Name <br /> ❑24 hrs L)72 hrs ~1 <br /> Date Time D e 1 Time }i j Date Time <br /> Distribution Whrte Laboratory Canary-Laboratory Pink ProiecifAccount Manager Goldenrod SampleNOriginetor i ` \ <br />