Laserfiche WebLink
LAk <br />ASSOCIATED LABORATORIES <br />806 N. Batavia • Orange. CA 92868 <br />(714) 771-6900 • Fax: (714) 538-1209 <br />CYA)NIOF CUSTODY RECORD <br />Date 1 Page — _ L of _ 1 <br />CLIENT�j� <br />ADDRES P <br />PROJECT MANAGER <br />Lab Use Only: <br />Samples Intact Yes No _ <br />County Seals Intact Yes No <br />Sample Ambient _Cooled _Frozen <br />Same Day 24 Hr. <br />Regular 48 Hr. <br />PHONE NUMB <br />r U J <br />PROJECT NAME <br />c ¢le -:7, G fi%%-il <br />SAMPLERS: ( ignature) <br />SAMPLE <br />NUMBER <br />LOCATION <br />DESCRIPTION <br />DATE <br />TIME <br />SAMPLE TYPE <br />NO OF <br />CNT RS <br />SUSP. <br />CONTAM. <br />TESTS <br />REQUIRED <br />WATER <br />AIR <br />SOLID <br />% <br />-7// <br />�O <br />�C ? sc� <br />6 <br />A <br />Rect'ived by: (Sign4ture) <br />j 1 I al f <br />1 V <br />Date,Tim- <br />/ <br />/ <br />I hereby authorize the performance of the above <br />indicated work. <br />PFF <br />Received by Laboratory for analysis: <br />(Signature)�� <br />�fC�-7 <br />Date, Mme <br />Soecial Instructions: <br />DISTRIBUTION: White with report. Yellow to AL, <br />Pink to Courief <br />