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ASSOCIATED LABORATORI <br /> 806 North Batavia e Orange CA 92868 *—LIA\ <br /> Chain of Custody Record Phone (714) 771-6900 ■ Fax (7I4) 538-1209 <br /> Pho <br /> Company� ��� /_+,,� A L Jab No � Page�of ' <br /> r lect Manage ~-yCJ Fa Analysis Requested Test Instructions& Comments <br /> �R. � � 56 9�,c-� �.s,to y q <br /> Project Name - + Project M <br /> Site Name �J r� '( f ti <br /> and <br /> Address <br /> � r <br /> Container <br /> Sample ID Lab ID Date Time Matrix Number/Size Pres <br /> 2 <br /> 3 , <br /> 4 <br /> 5 <br /> G <br /> 7 <br /> 8 <br /> I <br /> 9 <br /> 1a <br /> 11 <br /> 12 17 <br /> 13 <br /> 14 <br /> I <br /> 15 <br /> Relinquished by i Relinquished 2 Relinquished by 3 <br /> Sample Receipt-To Be Filled By Laboratory Sampler �-� &0 <br /> Cooled Y/N! Signatu Signature Signature <br /> Total Number 01 Containers Pro Pedy <br /> Custody Seals Y 1 N 1 A Samples Int t Y N!NA <br /> Prin ame�—Zl� Printed Name Printed Name <br /> 11 <br /> Samples Accept Y! patgg Time /�1 Qafe Time Dale Time <br /> Received in Good Conditi Y/)N P t57�. •13'� C <br /> Recelr gy Received By 2 Received By 3 <br /> Turn Around Time <br /> ;P <br /> ire Signature Signature <br /> ❑Same Day ❑48 hors Pnni Printed Name Printed Name <br /> Normal Rush p 24 hrs. o 72 hors <br /> Da Time :a Date Time Date Time <br /> Distrnbutwo white-Laboratory Canary-Laboratory Punk Project/Account Manager Goldenrod Sampler/Originator <br />