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M M M MtHAM OPRVDiMECMD = M M M 'Ir <br /> `'Advanced Technology FOR LABORATORY USE ONLY <br /> E� t;� Method of Transport Sample Condition Upon Receipt <br /> Laboratories Logged By Date 6 �}i'm. L0, Walk In 0 1 COOLER TEMP C (2f) 5 SEALED Y❑ N❑ <br /> Courier 9 2 CHILLED Y� N❑ 5 #OF SPLS MATCH COC YX NO <br /> 1510E 33rd Street Batch# D Ott UPS 13 <br /> Signal Hill CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) Y N❑ 7 PRESERVED Y❑ N❑ <br /> (310)989-4045 -FAX(310)989-4040 PO # ATL ❑ 4 CONTAINER INTACT Ve <br /> N❑ B CONTR !OT# <br /> Client GEOCON ENVIRONMENTAL - SACRAMENTO Address 3235 Sunnse Blvd #6 TEL ( 916 } 852 9118 <br /> Attn 'P City Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852 913 2 <br /> Project NameyC) Project# %[ � _r„2_ Sampler LFdnnteNarr*) (Signal <br /> l t,L� <br /> Relinquished by (suit.. I dby 45k9mU.e.ndPnntodName, 1� Date Jllltl2 � Time <br /> Relinquished by (sgnawi..n Received by ISynad.e rd Pn.W N m., Date G J Time <br /> Relinquished by (sgn.nx.end Pnm.d Nam.} Received by tsgnanr.and P.nwd N .i 1 r f Date Time <br /> (hereby authorize ATL to perform the work indicated below Send Report To Special InstructionslComments /� <br /> Unless otherwise Project Mgr/Submitter An (,�'n 5C;L <br /> requested all <br /> samples will be Date_ r Cc <br /> disposed 45 days Print Name J <br /> after receipt Address <br /> Signature City Slate—zip— <br /> SHIP <br /> tateZipSHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add v <br /> CIRCLE APPROPRIATEQA / QC <br /> (SUB CONTRACT) — _ (SUB CONTRACT)_ (SUB CONTRACT) Analysis{es} �� U 2� Z <br /> TEST TEST TEST flequesiea y am �� o tiO N MATRfX RTNE <br /> �p o Ur aT ?� O O <br /> ATL t ATL s ATL s �`° �' m U`' �m C n� is 5 ti� IiVYClCB ❑ <br /> DATE DATE DATE Q WIP ❑ <br /> a F R ¢` o " ❑ <br /> CLIENT I D CLIENT I D CLIENT I p <br /> � NAVY <br /> I LAB USE ONLY i��`�� my ��� r� v e� \�e `�� 7 �� LU t;�Q <br /> Sample Description %� m �O c� Container(s) to <br /> T Batch # o 0 0 o ha hQ c c O e 4 OTHEW <br /> E m� Dory° �Q �Q w <br /> M Lab NO Sample I D Date Time �o �o`v �o�� o o m c Ov Q �Q Q� �� TAT # Type Ir <br /> o m 4 O s' p a' p Yp a REMARKS <br /> 9_>1 oo r UJ -1G 02;)I a <br /> l <br /> GSD L I L <br /> co r-) Old �'� � 1!230 r <br /> SampleArcnrvaDispasaf Overnight Emergency I Critical Urgent Routine •TATstrtssam Preservatives <br /> © orhe Laboratory Standard TAT A� t 24 hr B` Next Workda , C` 22 WI orkda s l D= 3 Workda s E=7 Workda s following <br /> eW ad a�dn.3¢mp H=Hcl N=HNO3 S=H:SO. C=4 C <br /> ❑ Return To i Container T pes T=Tube V-VOA L=Lrter P=Pmt J=.lar B=Tedlar G=Glass P=PlasttC M=Metal ZaZn(AC)z O=NaOH T=Na:Sra <br /> "$10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to Colder Pink to submitter <br />