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• ASSOCATED LABORAaO IF* LA\ <br /> 806 North Batavia ■ Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714)538-1209 <br /> Company D Phon 2j,� '� s�/ A L Job No ' Page of <br /> Prosect Manager �( Fax Q 7 <br /> �'.C� <br /> Protect Name Analysis Requested Test Instructions&Comments <br /> r F, ' <br /> Site Name <br /> and tZ 7`( W to UU[�q U)i � <br /> _ <br /> Address C�R. �- /��—�� <br /> �f C•i - ;/ Container qq <br /> Sample ID Lab ID Date Time Matrix Pres til <br /> Number/Size � <br /> ' F'r-rtUiEWi 49':l,42-o-25 6;3 4-P2- � 7rb W. 14pt4r7-- <br /> 2 4P <br /> 3 <br /> 4 <br /> 501 <br /> 6 <br /> 7 <br /> S <br /> g <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 RelinRelinquished by 3 <br /> Sampler C�f7 {a�tf �17 <br /> Total Number of Containers Property Cooled Y/N/NA Signatu Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Pnnt, m� _A Printed Name Printed Name <br /> Y 1 CJ Dao i f L,0 <br /> � {r�Time Date TI Date Time <br /> _ I h <br /> Turn Around Time aeceigtuw - 1 Received By Received By 3 <br /> Signature Signature Signature <br /> Norma! ❑ Rush ©Same Day 048 hrS panted Name Pnnled Printed Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date Time Hate Time <br /> 13 r <br /> Distribution White Laboratory Canary Laboratory Pink Project/Accaunt Manager Goldenrod Sampler/Originator <br />