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i ASSOCIATED LABORATORIE40 <br /> 806 North Bcd via• ■ Orange CA 92868LA\ <br /> Chain of Custody Record Phone (714) 771-6900 . Fax (714) 538-1209 <br /> Company ©( ry <br /> C Phon 6-e I. / A L Job No Page of <br /> Project Manager �r Fax A yL✓� <br /> L� �J6Z -w- o� 1•�D Analysts Requested Test Instructions 8 Comments <br /> Project Name �'} w �'1� �-���r�!!L , Pro t R /y i <br /> Site Name <br /> and l/2 5-0 LV t— S[*f ,(, �/ •/� <br /> Address `--[elm cl� <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> L} <br /> Number/Size <br /> a 9V <br /> X XX <br /> b <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> Sample Receipt-To Be Filled By Laboratory Relinquished b 1 Rehnqut ed by _ �y Relinquished by 3 <br /> Sampler "MUV T7� <br /> Total Number of Containers Properly Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NASamples Intact Y/N/NA � S Panted Name y� Panted Name —panted Name <br /> Received In Good Condition Y/N Samples Accepted Y/N C) Dateot,jP 3,02 Time jii%?p_ Date Time Date Time <br /> Turn Around Time 11 Recarva�pyL7 Received 9y Received By 3 <br /> Signature Signature <br /> (� / Signature <br /> Ulormai '�+�+ Rush ❑S e Day ❑48 hrs Printed Name Printed Name <br /> Panted Name keN 0rye <br /> Dale Tuna Date D IC �TiWme 11, a Date Time <br /> r E,;j 1 <br /> Distribution White Laboratory Canary Laboratory Pork Project/Account Manager Goldenrod-Sampler/Onginalor <br />