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M MRHAW oMu D10MCMD i■r <br /> -fflVIdvanced Technology FOR LABORATORY USE ONLY <br /> I Method of Transport Sample Condition Upon Receipt <br /> Laboratories Logged By Date 40-LC kme tGD5 Walk in ❑ 1 COOLERTEMP C (2-6} 5 SEALED YO N❑ <br /> 1510 E 33rd Street Batch DO # UPS Courier © 2 CHILLED Y X N❑ 6 #OF SKS MATCH COC YX N O <br /> Signal Hill GA 90807 <br /> FED EXP ❑ 3 HEADSPACE(VOA) Y❑ NO 7 PRESERVED Y❑ N❑ <br /> (310)989-4045 •FAX(310)989-4040 'PO # ATL ❑ 4 CONTAINER INTACT Y), N❑ 8 CONTR LOT It <br /> Client GEOCON�ENVIRNMENTAL SACRAMENTO Address 3235 Sunrise Blvd #6 TEL ( 916 J 852 9118 <br /> Attn (�,� <br /> City Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852-9132 <br /> Project Name �. nnied Name <br /> 1 } r,Up Project# sampler "" _ �- <br /> Relinquished by (signal—and Pnmd Namiv b v. N <br /> (f le) Date Tlme <br /> Relinquished by (Sgname and Rimed Name) Received by (Sgnaea.and as Name' <br /> Relinquished (SgnaW.andRmldNa . Date Time `� <br /> q Y ) Received by (Sig—U­ane Fnm Nam.) <br /> Date Time <br /> I hereby authorize ATL to perforin the work indicated below Send Report To Special Instrumons/Comments <br /> Unless ta Protect Mgr/Submitter Attn CgJ� 55u)� <br /> requessteded all all <br /> samples will be Date r Ca ( ,Q r�- t <br /> disposed 45 mays Pnnt Name �� JQs-Tv t-' r�R / <br /> atter receipt Address /� p <br /> Sgnawre City State Zip �%� <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add o CIRCLE APPROPRIATE A 1 C <br /> (SUB CONTRACTL _ (SUB CONTRACT}_ - (SUB CONTRACT) � U � <br /> TEST TEST Analysis(esJ OL mh ` Oma' MATRfX Z <br /> TEST Requested �" \ro G RTNE ❑ <br /> ATL x ATL x AFL x �° �� ` 44 JQ �tv- O RWQCB ❑ <br /> DATE DATE DATE Q W1P ❑ <br /> CLIENT I 0 CLIENT I p CLIENT i D ma eyo ��5 `o����} �o �jv �"� �[�Q > NAVY ❑ <br /> I LAB USE ONLY z� �� my �� a� c� o. ���ze h2 <br /> W CT <br /> T Batch # Sample Description ,ti ry� �` Porti^m `Qz y O" Q ?3 Container(s) OTHER <br /> E �o �� �c roti �ti � � � IO � ,�<a ?� � �Q' � <br /> h M Lab No Sample I D DatUJI <br /> e Time moo, �� boor s �ryh 0y mh p m �o �• � oe Q TAT # Type ^a- REMARKS <br /> {� <br /> mDL;C <br /> yr01 <br /> - I FA <br /> ,c 1 <br /> t I v .0 <br /> tC, <br /> vJ — I <br /> SampleArcn"e,Disposai Overnight Emergency Critical Urgent Routine •TAT Sam Preservatives <br /> © Laboratory Standard TAT A- 24 hr B= Next gency I C= 2 rnical a s D. 3 Workdays E= Routine <br /> a S lollowarg day H samples <br /> ❑ Othe reoaived atter 3 m H=Hcl N-HNO� S=HMSO+ C=4 C <br /> ❑ Reurm To Container T pes T=Tube V=VOA L=Liter P=Pent J=.1 it B=Tedlar G=Glass P=Plastic M=Metal Z-Zn(AC)x O--NaOH T=NaS� <br /> $10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to tolder Pink to submitter <br />