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S ASSOCIATED LABORATORIEW <br /> 806 North Bartavia • Orange CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fox (714) 5,38 1209 <br /> Company 'C r 0/ C— C,&— Phnn ��� —3 6 O A L Job No <br /> Li Page of <br /> Protect ManagerFax <br /> S-UR / -(�f�cj'V L y �` - •((� Analysis Requested test Instructions & Comments <br /> Protect Name � � f l �-y 4 Projet4t IfSite <br /> Name <br /> and J21 —0 rJ ,fJr p B <br /> Address :5 O 62-- ✓ " <br /> I D 6 01 y r 0 <br /> )�)2— <br /> P <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres j iC <br /> z kw it A 161 Cu POP �Y����_ <br /> 3 �JPxi XX I I I Co p�C/� d5 U �►D <br /> s MW 3 1 4kiiTkle)b 92-60 <br /> s T-b i <br /> 16 <br /> g '-���I � � !V�:--iG�+lri�� J100-10Ili o3 <br /> 1 10 <br /> 71UP Q X5,00 g2-O 2-VV& 14t X <br /> 12 <br /> 13 <br /> t5 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by � „ 1. Relinquished %�, 2 Relinquished by 3 <br /> Sampier f7r ( �+ <br /> Total Number of Containers Z9 Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NA t[_? Samples Intact Y/N/NA f Partied Na�pr � V Printed Name Printed Name <br /> Received In Good Condition Y/N Samples Accepted Y!N F/Pr9 Date Time /n Date Time Date Time <br /> Turn Around Time 1I Racal vt.d s &� �[�(Y Recel x Received 3 <br /> Signature St urs Signature <br /> L ❑Same Da ❑48 hrs F <br /> Normal ❑ Rush Y Pnnied Name Printed Na Panted Name <br /> ❑24 hrs ❑72 hrs <br /> Date Time Date Time <br /> Time <br /> (` r <br /> bistrrbution Wtute-Laboratory Canary Laboratory pink Prorecl/Account Manager Goldenrod Sampler/Originator b <br />