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3 <br /> ASSOCIATED LABORATORIES <br /> 806 North Batavia s Orange CA 92868 <br /> r <br /> Chain of Custody Record <br /> �%(Z3 Phone (714) 771-6900 ■ Fax (714) 538-1209 M <br /> Company F Phone 11 7 - , <br /> A L Job No Page of <br /> Project Manager t Fax Analysts Requested Test Instructions&Comments <br /> Profect Name jj� h ' j Project J^j <br /> !: �� <br /> Site Name I C l <br /> and f ,3 �� G/��;� �!•�' 6 � � ' <br /> Address <br /> cv <br /> Sample ID Lab ID Date Time Matrix Container Pres <br /> Number/Size j L� <br /> ireoi;Y <br /> �l � fry =� 7 t `'�k-4r✓ !.P� 0q J& 00 .�) lP,,q <br /> \ <br /> T � #/ � � �- <br /> to <br /> 11 <br /> 72 <br /> i3 <br /> 14 �� <br /> 15 <br /> Sample Receipt-TO Be Filled 8y Laboratory Sampler by 1 Relinquished by 2 Relinquished by 3 <br /> $am ler• <br /> Total Number of Containers Property Cooled Y f N f NA Signature . Signature Signature <br /> Custody Seals Y!N/NA Samples Intact Y/N/NA Printed Name {^ {� Pr+nted Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N y pate, Time date Time Date Time <br /> 1 ZL=�✓J <br /> Turn Around Time Received By Received By 2 Received By 3 <br /> Si signature Signature <br /> Normal Ll Rush LI Same Day 0 48 hrS sne Printed game Printed Name <br /> ❑24 hrs ❑72 hrsis <br /> Time Date Time Date Time <br />