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I <br /> American Environmental Testing Laboratory Inco <br /> t� <br /> 2834 North Naomi Street Burbank CA 91504 • DOHS NO 1541 1 ACSD NO 10181 CHAIN OF CUSTODY RECOR <br /> y Tel (888)288-AETL• (818)845-8200• I-ax (818)845-8840 <br /> COMPANY PHONE <br /> 5o'Z �Z/ — �'S D�f AETL JOB No O 1 /I <br /> 'l 0 1 •^T Page ��of <br /> PROJECT MANAGER FAX <br /> U�� ANALYSIS REDUESTED TEST INSTRUCTIONS&COMMEN <br /> PROJECT NAME <br /> VOL,)1/.G.-11O P_ C. !� PROJECT 11 <br /> SITE NAME ►J Y Y <br /> AND <br /> ADDRESSLCD' / <br /> SAMPLE ID / LAB ID DATE r`f TIME MATRIX CONTAINER PRIES <br /> ?B (2V tit )1 00 <br /> ' 16 9v Q <br /> XI X:� X <br /> 6- <br /> MW x <br /> ' ?B67B4 -t a )c <br /> nn r+o; <br /> e X <br /> 9 <br /> h <br /> 1j <br /> SAMPLE RECEIPT-TO BE FILLED BY LABORATORY SAMPLER 1 RELINQUISHEDBY 2 R£ I 3 <br /> TOTAL NUMBER OF CONTAINERS 7 PROPERLY COOLED Y/N!NA gn�him gn�tu'q gnature <br /> CUSTODY SEAL5 Y/N A SAMPLES INIAC Y N!NA Mime t nntuu Namu <br /> RECEIVED IN GOOD COND Y/ SAMPLES ACCEPTED Y N Ddie TunaData Time nate <br /> t 1 -0 0 .00 Time <br /> TURN AROUND TIME RECEIVED BY RECEIVED BY 2 RECEIVED BY <br /> LAB RAT3 <br />� Signature DRY Signature � <br /> UeNORMAL RUSH ❑ SAME DAY ❑48 HRS <br /> ❑ 24 HRS ❑72 HRS Printed Name Printed Name rrn e <br /> Dale Time Date Tome a e <br /> lime <br /> DISTRIBUTION WHITE-Laboratory, CANARY-Laboratory, PINK-Project/Account Manager, YELLOW-Sampler/Originator <br />