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M M ERHAM oP6UEWQ1WC@ft = = = = M <br /> IkAPFAdvanced Technology ' FOR LABORATORY USE ONLY <br /> L �� ,,,,tMethod of Transport Sample Condition Upon Receipt <br /> Laboratories Logged By Date G e �l`� Walk in ❑ 1 COOLERTEMP C �/;(2-6) 5 SEALED Y❑ N[711510E 33rd Street <br /> Courier 6 2 CHILLED Y� N❑ 6 A OF SPLS MATCHCOC YX N❑ <br /> Batch# 0 O # UPS ❑ <br /> Sinal Hail CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) Y❑ N❑ 7 PRESERVED Y❑ N O <br /> (310)989-4045 e FAX (310)989-4040 P O # ATL ❑ 4 CONTAINER INTACT Y t N❑ 8 CONTR LOT* <br /> Client GEOCON ENVIRONMENTAL - SACRAMENTO Address 3235 Sunrise Blvd #s 1TEL ( g16 ) 852 9118 <br /> Attn City Rancho Cordova State CA Zip Code 95742 FAX( 916 } 852 9 132 <br /> Project Name )i L-10 ID Project# �J�L-,)D— C C „��Sampler 'tedNarrel f Is <br /> T1 � .� <br /> Relinquished by I . y�+ram tsy�..,r.Wd Prmw a.m., .,I `,n Date ^ ime r' <br /> Relinquished by ( r•+� C C �•- 0 Received by tsgnaa..rdPr~ F x "Y Date Time � <br /> Relinquished by Isrgnad,i.and Prm<w Names r Received by I*mu*and Pru+nd aam.y r r "i j h 1 �r Date y Time (� <br /> I hereby authorcze ATL to perform the work indicated below Send Reoort To Special Instructions/Comments <br /> Unless otherwise Project Mgr/Submitter Ann <br /> �t <br /> requested all �] <br /> samples will be Date___ Co <br /> disposed 45 days Prue Name <br /> after receipt Address <br /> SiOnature City Slate—ZIP-1 <br /> SHIP TO LAS SHIP TO LAB SHIP TO LAB Circle or Add G CIRCLE APPROPRIATE Q A / Q C <br /> (SUB CONTRACT] (SUB CONTRACTi (SUB CONTRACT) U <br /> Requested <br /> U° m" ��= MATRIX RTNE ❑ <br /> TEST TEST TEST Requested y a y. e Q p <br /> ATL r ATL# ATL s o U UU 0 ` O� JO h� RWQCS ❑ <br /> DATE DATE DATEo FP` RVm ory Vv JJ �� Q Q WIP ❑ <br /> CLIENT I D CLIENT I D CLIENT I D ��� It°y s�U� �- sm y F. y �� � NAVY n <br /> I 8 ti�j oy oo` �r ti O ¢� d O� �'v2 yam tirvq Lu CT <br /> LAB USE ONLY Sample Description m Q mar ar r7 c� Container(s) <br /> T Batch# o sa �o bo o ti .a O Q ? �� w OTHER <br /> o bo" o ti ti `T S0 Q <br /> p �� m �� �@ m cy e ro O z� p y��O� TAT # Type a! REMARKS <br /> Lab No Sample I D Date Time o oti o� r� o o m m` Q �e �� <br /> �- L& <br /> M-0 -'40 <br /> TU P <br /> I I <br /> I I <br /> SamWe Arcdvve/Disposal TAT siarists 6 am <br /> ❑ Laboratory Standard TAT A= Overnight B. Einer en Cs Critical D� Lir ent E= Routine follow <br /> AT sg day M samplrrs Preservatives <br /> ❑ otne <_ 24 h 9 Next woli�da I2 Workda s 3 Workda s 7 Workdays recarvedaner 3 m H=HCl N=HNa S=HMSO. C=4 C <br /> ❑ Return To Container Types T=Tube V-VOA L=Leer P=Pint J--Jar B=Tedlar G=Glass P=Plastic M=Metal Z=Zn(AC)2 O--NaOH T=N&S2a <br /> *S1000 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to tolder Pink to submeter <br />