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WHAMOMU DVWCWD M M M M -�dvanced Technology FOR LABORATORY USE ONLY Method of Transport Sample Condition Upon Receipt Laboratories Logged By + Date �� =Time� � Walk in ❑ 1 COOLERTEMP C (2-s) 5 SEALED Y❑ N❑ Courier 2_72 CHILLED Y9 N❑ 6 1 OF SPLS MATCH COC Y Iii, N❑ 1510E 33rd Street Batch# DO # UPS ElFEDHill CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) YIDNEI7 PRESERVED Y❑ N[I (3I0)989-4045•FAX(3I0)9894040 PO # ATL ❑ 4 CONTAINER INTACT Y I)P N© 8 CONTR LOTat Client GEOC N EN VIR MENTAL - SACRAMENTO Address 3235 Sunrise Blvd #6 TEL i 916 1852 91 1 9--~ Attu City Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852 9 132 Project Nam Project# `2 _r„ Sampler-Z"" 1� ;sena re Relinquished by (SgnO...nd Pnn,ed N Fd b C�Is,9�!Lwv and q,� L r u tY Date Relinquished by IsgnetW..nd PnM.d u..,.i Received by Is q—e ..c, .i !U Date f1 U 7 0 Time L it •� Relinquished by (sgnae,r.r d rmm.d fi m.i Receiveo by Is9mL—rd Pnnm —., Date Time I hereby authon7e ATL to perform the work indicated below Send Report To Speaal Instructions/Comments Unless otherwise Project Mgr/Submitter Ann requested all samples will be Date i I Cc disposed 45 days Pnni Name after receipt Address Signature City State Zip SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add v CIRCLE APPROPRIATE A / C (SUBCONTRACT)- -- (SUBCONTRACT). (SUBCONTRACT! Analysis les) OGS h Q2� MATRIX Z TEST TEST TEST Requested O RINE ❑ ATL s ATL;F ATL+! a° s° 0ti UOQ �_ {4 J� �(iQ RWQCB ❑ DATE DATE DATE o Fa QG ,m'' �� L Jo �� Q WIP ❑ CLIENT I D WENT I D CLIENT 10 �� ° o V } "m �v �� cccc NAVY R,} W CIT I LAB USE ONLY m � m s s g o � � � >� Sample Description a e ` a .p �, c� Container(sj T Batch# p p Aon OTHER E m° o° ao mry oti .y �� i.� �� G� Lab No Samples € D Date Time �o roti �� p �" �" s° �a� o. $,r ce` g �¢ o TAT # Type a REMARKS { i i I I i 4V GA Sample Arcnrve/Disposat Overnight Emergency CrtUca) Urgent Routine TAT stwts8am Preservalves ❑ Laboratory Standard TAT A= I3= C= I D= E� following day 1t samples ❑ Omer <24 hr Next workda 2 Workda s 3 Workda s Workdays Teceerad atur 3 m H=Hct N=HNa S=H-SO. C-4 C ❑ Return To Container T Des T=Tube V=VOA L=Liter P=Pmt J--Jar B=Tedlar G=Glass P=Plastic M=Metal I Z=Zn(AC)- O--NaOH T=Na.2S? a '$10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to folder Pink to submitter