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*erican Environmental Testing Laboratory Inc • <br /> E CHAIN OF CUSTODY CORD <br /> 2834 Norih N-tomt Street Burbank.CA 91504 • DOHS NO 1541,LACSD NO 10181 <br /> Tel (8 88)288-AETL• (8I8)845-8200-Fax (818)845-8840 <br /> COMPANYT P&I I <br /> AETL JOS No I 0 fPage_� of <br /> PROJECT MANAGER FAX ANALYSIS REQUESTED <br /> r— V V Ahyor5U�{ TEST INSTRUCTIONS R COMMENTS <br /> PROJECT NAW V �D P, ! PROJECT# <br /> SITE NAME 2,5-p W li CS^'"U-n JJ t ,{j •�!� ` i 1 <br /> AND T vy <br /> ADDRESS a-7-0c V 7-r t4 (y� � <br /> I `/r'1- CONTAINER r <br /> SAMPLE ID LAB ID DATE TIME MATRIX NUMBER/SIZE FRES c <br /> I NGF_ Ae Z3 S 8 ,15o x X <br /> ?$ -- 12-V - C'3` c ITO <br /> TP, r- 2w 8 e ,-o <br /> T e U AMM I 1 :w e <br /> 7_12-5 :toX XIX <br /> MW-!S q k' -�o X. <br /> 1-6 20 <br /> 13 <br /> SAMPLE RECEIPT-TO BE FILLED BY LABORATORY RELINQUISHED BY RELINQUISHED BY 2 INQUISHED BY <br /> SAMPLER <br /> TOTAL NUMBER OF CONTAINERSPROPERLY COOLS Y/N/ A Signature Signature Signature <br /> CUSTODY SEALS YIN/ A SAMPLES INTACT N/NA Printed Name Printed Name Printed Na <br /> RECEIVED IN GOOD CON /N SAMPLESACCEPTS Y N Das., / Time Dat Time e Time <br /> �/J fj Q1� <br /> TURN AROUND TIME RECEIVED BY 1 RECEIVED BY 2 RECEIVED BY 3 <br /> LABORATORY <br /> Signature Signature Signatur� <br /> WNORMAL RUSH ❑ SAME DAY ❑48 HR5 ����f� <br /> Printed Name Printed Name Print�Name <br /> ❑ 24 HRS ❑72 HRS <br /> L" I� <br /> ate Time Time Date 4:1e y Time r <br /> 21 <br /> dig q, <br /> DISTRIBUTION WHITE-Laboratory, CANARY-Laboratory, PINK-Project/Account Manager, YELLOW-Sampler/Originator <br />