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• ASSOCIATED LAS01ZATORIE6 <br /> 806 North Batavia - Orange, CA 92868 <br /> Chain of Custody Record Phone (714) 771-6900 Fax (714) 538-1209 <br /> Company .ri1n,Fy— �' � � � Phon � ? /r / A L Job No �r�� Page of <br /> Protect Manager b �F A i4g Fax r l <br /> .V Analysis Requested Test instructions&Comments <br /> Protect Name %IJ fr Pmt t# <br /> Site Name /y <br /> and t f <br /> Address f T <br /> Sample ID Lab ID Date Time Matrix Container Pres 61 a <br /> Number/Size Y- <br /> ' , 1©, 0 2 <br /> 2 01 ID . 02- 44"460p, d GAP Nob4r X ? � <br /> 3 <br /> 4 <br /> 5 <br /> I <br /> 6 <br /> 7 <br /> ti <br /> 9 <br /> 10 <br /> 1 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished b 1 Reltnqui bgd Relinquished by 3 <br /> Sampler (� JbA4 <br /> Total Number of Containers Properly Cooled Y/N/NA ff r Signature i r Signature Signature <br /> J <br /> Custody Seals Y/N/NA ffl o Samples Intact Y/N/NA Printed Name Pnnted Name Printed Name <br /> Received in Good Condition Y/N f Samples Accepted Y/N �� Date (y, €me i Date Time Date Time <br /> Turn Around Time Receivedjy ] Received By Received By- 3 <br /> L VM I <br /> Signature Signature Signature <br /> �.1 Normal U Rush Ll <br /> Same Day ❑48 hrs Pnnted Name Pnnted N �Q Printed Name <br /> ❑24 hrs ❑72 hrs _ <br /> Date Time Date Timo l ji Date Time <br /> Distnb ubon White-Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod Sampler/Ongmator L <br />