Laserfiche WebLink
�• *erican Environmental Testing Labol atory Inc. <br /> CHAIN OF CUSTODY R CORD <br /> } 2834 Nuliil Naomi Surd 11talu k,CA 91504 - DOIIS NO 1541 1 ACS[)NO 10181 <br /> lei (888)288-AF Cl - (818)845-8200-lax (818)845-8840 <br /> COMPANY PONE � AETL JO$ No7 © . LJ Page j of T <br /> PROJECT MANAGER !-AA ANALYSIS REQUESTED <br /> ��r �`(f� �i'~.tJ5vM19- TEST INSTRUCTIONS&COMMENTS <br /> PROJECT NAME - PROJECT it / 0 <br /> SITE NAME �?CD ]�, wit- 50N <br /> �/1\ t- 5 O N ��Jif, ` <br /> AND GJ + V v t V v Y <br /> ADDRESS _1_0 C'K_TON c4 95zo? <br /> SAMPLE ID LAB ID DATE TIME MATRIX CONTAINER ARES p� <br /> NUMBER/SIZE <br /> r 6 ? r s- off' t 00 �=oa Wt Fr .iL 3 v'r 5 h�c(— XAN,RL 8r R ur,eeED <br /> ' M w O X 'Fr D Ot�it� t USD <br /> M ui-6- AV c is`l <br /> U <br /> T8 20 XI "KIxi 0R-kFTtFt)0 246o <br /> (� RE r^Lr f t�• 2 X MF.�'tFf�t�oL <br /> r M W-Z- <br /> M W-M, A g64 Vv 0, LC 3T�-RG7 Buv v� <br /> erg x1x <br /> Mw-G E t+ ��: x ?c "�rPF_ <br /> rAr $L" l'fctr 1- '-00 Z v rf—'S l� <br /> I <br /> i <br /> SAMPLE RECEIPT-TO BE FILLED BY LABORATORY R RELINQUISHED BY RELINQUISHED BY <br /> SAMPLER <br /> PROPERLY COOLED Y N/NA Signature Signature gnature <br /> TOTAL NUMBER OF CONTAINERS / <br /> CUSTODY SEALS Y! ! A SAMPLES INTAC Y 1h!NA Printed Name 15F p Printed Name Printed Name <br /> SAMPLES ACCEPTE Y N D11e Time r Date Time Date Turin <br /> RECEIVED IN GOOD COND Y N 0� �rOQ =00 <br /> TURN AROUND TIME RECEIVED BY RECEIVED BY RECEIVED BY 3 <br /> LABORATORY <br /> Signature Signature Signalur <br /> ❑ SAME DAY ❑48 HRS <br /> NORMAL RUSH Printed Name Printed Name Pr, d Name <br /> ❑ 24 HRS ❑72 HRS �/�/�!•� rG/i1 � <br /> ate Time ate Time Date E r, f J Time <br /> DISTRIBUTION WHITE-Laboratory, CANARY-Laboratory, PINK-Project/Account Manager, YELLOW-Sampler/Originator P!I~Cr.1 V td $� E�Q 1 C[F_A 5+u <br />