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1r AM M mom M M » M r 4rlir <br /> CHAIN OF CUSTODY RECORD Pg of <br /> FOR LABORATORY USE ONLY <br /> Method of Transport Sample Condition Upon Receipt <br /> Advanced Technology Client ❑ 1 CHILLED Y19 N❑ 4 SEALED Y ❑ N 0 r <br /> Laboratories P Q ATL ❑ �f' L <br /> 3275 Walnut Avenue / CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N❑ 5 N OF SPLS MATCH COC Y❑ N 11 <br /> Signal Hill,CA 90755 Logged BY Pt- Date �'� FEDEX to <br /> (562)989-4045 - Fax(562)989-4040 Other 3 CONTAINER INTACT Y❑ 1>} 6 PRESERVED Y 1 N f� " <br /> Client 25 C(OA Address 5-7 LA I( 3 e" c Jic iZ 7-ivA fll""` TEL ( CJ <br /> Attn f''ter1 0 .St"rnlJ city Ftr7e#.e— State zap Code aiFAX({ZS ) 2gq.430 t <br /> Sam ler (Printed Name) (s��` <br /> Project Name C�� TyA1�5 Project# P ggor 13ig6 DO v� cit-f-r X� <br /> Rehnqulshedby{s ...-dPeniedN�el C'IrFT Date It? lZ Time 0V Received by(s ��adNumt �`f Date Je, 1z tl Time It V( <br /> Relinquished by(&".�A Pnnbd Nwm) Date Time Received by (sigmm.-w Pried N.—) Date Time <br /> Relinquished by(sw w"and A med Nemo) Date Time Received by(stele am Prwed Name) Date Time <br /> I hereby sutttorize ATL to perform the work Send Report To Bill To Special In istructgnslComments // <br /> indicated below Attn t( ern Attn � '— (Aft mvVio Wlk gAe7fiol5 <br /> Project Mgr/Submitter <br /> co S 6LD i2 e... co <br /> Pml Name Date Address <br /> pp����}p�p^7�7 {�/�/�[�r-�+aJ Address <br /> SMaNrecity <br /> LAEA Stat9"F _Zip_ City State—Zip <br /> Sample/Records-Archival&Uianosal Circle or Add SPECIFY APPROPRIATE �C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after R�ueisf s) ��L'/ G MATRIX O RTNE ❑ <br /> receipt and records will be disposed 1 year after submittal of final report r�'� -v - CT ❑ <br /> Storage Fees(applies when storage is requested) <br /> •Sample $2 001 sample/mo(after 45 days) 0 N Q- o, SWRCB ❑ <br /> $ �v <br /> -Records $1 OO/ATL workorder 1 mo(after 1 year) �c �^ !��' a� �4rQ Lagcode <br /> I LAB USE ONLY o3 Container(s) rn <br /> Sam le Desch tion o ` ay OTHER <br /> E Batch#Lab No Sample I D /Location Date Time g �'�' ho s'��Qo�p FAT # Type a REMARKS <br /> M Y�t, K <br /> W.I3 ►t) 11 13,10 X X r 3 v il' <br /> r{l l di M- I 1a^11 <br /> F_ V; µ <br /> VM -2, IC411 <br /> V L <br /> i <br /> { <br /> TAT starts 8 a m following day d TAT A= Oveml ht B Emergency Cntical Urgent Routine Pr rvatives <br /> 9 <24 hr Next workda C= 2 Workda s D= 3 Workda s U 7 Workdays s =H N=HN& S=HMSO+ C=4 C <br /> samples received after 3 p mContainer T es T=Tube V=VO L=Lite P=Pint J--Jar B=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AC)x O=NaOH T=Na2SzO3 <br /> v-n—. •n 4-1ol r �rw4 M cnY+mNMnr <br />