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ASSOCIATED LABORATORI LA <br /> 806 North Batavia a Orcmge CA 92868 <br /> Chain of Custody Record Phone (714) 771-6400 - Fax (714) 538-1209 <br /> Company 7-y 2� ,.. o,-L r ,o Pho lUl/-35 <br /> 2J 5 9� A L Job No V $ 0 Page of <br /> Project Manager ,d HCl Fax �^ <br /> &fft �! SUr-�I�— w- qQ�--?'5tp Analysis Requested Test Instructions & Comments <br /> Project Name �r P- #4� ^ (�N-� Prot <br /> aS;tend Name I } (� h <br /> and 1-4 �[ � 1 <br /> Address t <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size )O f2- <br /> z <br /> 3 <br /> I <br /> 4 <br /> 5 <br /> i <br /> 6 <br /> a <br /> 9 <br /> 10 <br /> 11 <br /> 12 '! <br /> 13 ' <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Reiinguished b 1 Relin coshed by Relinquished by 3 <br /> Sampler <br /> Total Number of Contarne Properly Cooled /NA Ssgnatur C- � Signature Signature <br /> Custody Seals Y! /NA Samples Int t Y/ NA PFIntpd Name� Printed Name Printed Name <br /> Received in Good Conddi n Y! Samples AcceptY/ Date Time�ljy�o Date Time Date Time <br /> Turn Around Time Received 1 i Received By 2 Received By 3 <br /> xw Signature vim, 117� <br /> Signature Signature <br /> CYNorma! RUSK ❑Same Day ❑48 hrs Pnnted a / .. Printed Name Printed Name <br /> ❑24 hrs Ll 72 hrs fj`GW <br /> Date v Time p Date Time Date Time <br /> ral <br /> Mstnbtdion Whrte Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Samplar/Originator <br />