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CHAIN OF CUSTODY RECORD Pg_/__of <br /> FOR LABORATORY USE ONLY: <br /> Advanced TBChfma Method of Transport Sample Condition Upon Receipt <br /> Client ❑ 1.CHILLED �/Yp N❑ 4.SEALED Y❑ N ❑ <br /> Laboratories P.O* ATL ❑ <br /> 3275 Walnut Avenue JA 0 2 CA OverN ❑ 2.HEADSPACE(VOA) Y❑ NO 5AOFSPLSMATCH000 Y❑ N ❑ <br /> Signal Hill,CA 90755 Logged By: Date: FEDEX <br /> (562)989-4045 • Fax(562)989-4040 pQ Is kh ArTAL HEALTH Other: 3.CONTAINER INTACT Y❑ NO &PRESERVED Y ❑ N ❑ <br /> Client: GEOCON CONSULT �Tls <br /> Address; 3160 Gold Valley Drive, Suite 800 TEL ( 916 ) 852-9118 <br /> Attn: J��{/ ��y / city Rancho Cordova state CA Zip Code F ) 852-9132 <br /> Project Name: Project#: Sampler: t° ntee Rems) s <br /> G/��� S`IF��_O/© 6/f.✓�i19/�F <br /> Relinquished by:tseww.mi Pdmw rrm.) Date: Time:/.SGlj.Received by:Isyww...d PdmdName) Date:�� Time:/_5Zv <br /> Relinquished by:(&ra .wrnmawm.) Date: Time: Received by:tsa..im"Pdmwnv..l Date: � � I Time: <br /> Relmquishedby:(sgiww•.w Pdmwu .) Date: Time: Received by:csgww.w Pdmw tmm.) Dete: Time: <br /> I hereby authorize ATL to perform the work Send Report To: B0 To: Special Instructions/Comments: <br /> indicated below: Attm _fes / 1C <br /> Project Mgr/Submitter: •�( Attn: <br /> co: Co: <br /> A <br /> me ere <br /> Address Address <br /> nal Ci State—Zip CRY State_Zip_ <br /> mnlafR ...dal-Arvirtival&Disposal Chole or Add �'/ SPECIFYAPPROPRIATE Q A�C <br /> Upffss oche se requested by client,all samples will be disposed 45 days after r lueisied) MATRIX Z RTNE ❑ <br /> receipt and records will be disposed 1 year after submittal of final report. eq V CT ❑ <br /> Storage Fees(applies when storage is requested): LL ~ <br /> •Sample :$2.00/sample/mo(after 45 days) , 'S f > SWRCB ❑ <br /> •Records:$1.00/ATL workorder/mo(after 1 year) _ <br /> 6 <br /> I LAB USE ONLY: Sample Description m � e a�P Contalner(s) tu <br /> T Batch#: @ �+ Zt o o �e J? •r.� w <br /> M Lab No. Sample I.D./Location D to Time � OTHER— <br /> ry �& 3r neo�e Tar # Type a REMARKS <br /> } < C_ OU <br /> v 13 Z-Sr,a Y° f <br /> - r Z_/40 <br /> Smc <br /> /s,- <br /> (D <br /> w � <br /> o <br /> o Overnight Emergency Gdtical Ur ant Routine Preservatives: <br /> wo •TAT starts 8 a.m.following day if TAT:A= B C= .. D= E_ <br /> ser' eceived after 3 p.m. 5 24 hr Next workda Work a s 3 orkda s 7 Workda s H=HcI N=HNO. "SO. C=4'C <br /> Container Ty es: T=Tube V=VOA L--Liter J=Jar B=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AG). O=Na T=NaS.O. <br /> .....�.,.. ,T...,. ...u._...uw.-_,... v..n..........aw... err..............w... <br />