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ASSOCIATED LABORATORI,O <br /> Chain of CustodyRd 806 North &rtavla • 4rcmge, CA 92868LA\ <br /> ecorPhone (7I4) 771-6900 Fax (714) 538-1209 <br /> 0 <br /> Company ^� Phon C� p <br /> Protect Managere L �GZ r��^3✓ p 9 A L Jot}No Page of <br /> Fax <br /> Protect NameIc Analysts Requested Test Instructions&Comments <br /> !�)' 1/0- <br /> J 0- s Protect# 16L <br /> Site Name <br /> and � q ' ,�r12-6c) H, W r L-�� V V <br /> Address <br /> SMC97-0/4 CA 6-110 ly— <br /> Sample ID Lab ID DateTime Matrix Container P <br /> Number/Size Pres r <br /> o c2 5'' Vt 3 V1'!3 ti CL X �� BTPS Q vik.�.a4 <br /> ox � � <br /> a 'I g—�o <br /> rN CA. <br /> oto 290 <br /> 6 <br /> r P <br /> l6rno <br /> M LV2 Z 5TF1ff HqL- <br /> w, 6 �G f -P�1�7� al/TitYta <br /> ' 'Twp awe E�X r PF <br /> t, <br /> 12 <br /> 13 ► (T1`t f <br /> L14 <br /> �f <br /> Sample Receipt-To Be Filled By Laboratory Relinquished by 1 Relinquished by 2 Relinquished by 3 <br /> Sampler <br /> Total Number of ContainersZ41 Properly Cooled Y/N/NA Signature r� Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA �/ Printed Name Pnnted Name Panted Name <br /> Q" <br /> Received in Good Condition Y/N Samples Accepted Y/N Date,,.,M Time Bale Time bate Time <br /> / Turn Around Time Received By 1 Received By 2 Received By 3 <br /> / ig Signature Signature <br /> ❑Same Day ❑48 hrs <br /> P <br /> Normal Ll Rushami ) Panted Name Printed Name <br /> ❑24 hrs 0172 hrs ,., 7 <br /> L !,� Time Date Time Date <br /> Time <br /> Distributlon White Laboratory Canary Laboratory Pink Project/Account Manager Goldenrod Sampler/Originator <br />