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r■� r1� w� � �s r� � � � air �r � r �r �■r �.1 � <br /> CHAIN OF CUSTODY RECORD Pg=J==Of <br /> FOR LABORATORY USE ONLY <br /> ® Advanced Technology MechBtdof Transport Sample Condition Upon Receipt <br /> t CHILLED Y lg N[1 4 SEALED Y N-11 <br /> LaboTateneS ?o lf ATL ❑ <br /> 3275 Walnut Avenue <br /> CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N E35 1 OF SPLS MATCH COC Y(]r N ❑ <br /> Signal Hill,CA 90755 <br /> Logged BY Date Y FEDEX ® // <br /> 10 <br /> (562)989-4045 • Fax(562)989-4040 Other 3 CONTAINER INTACT Y❑/N❑ 6 PRESERVED Y❑ N <br /> Client c o 2 Address -j LA r f? e 1i P— C I' ! and F1o9!` TEL (g 25 } 2-19`9�oa <br /> SCG <br /> Attn 444)0 Stet,VI A City I.AF a State C R Zip Coda � � FAX( ) 24 — <br /> M z <br /> j Name Project# Sampler (Prmted Name) (Signature) <br /> Project CSI"TP4v)] Ll Lin rW3jy DO p 6 A y CI4T <br /> Relinquished by istipa1tmsindPr...aNsm.1 -m ClXr Date 1,0-zl <br /> Time L00 Received by tsyroaroendvl.twN•m.l Date Time r) <br /> Relinquished by tswotVeaid ftw Ne I Date Time Received by(SlytrElmxW PrNt@dNe ) Date Time <br /> Relinquished by iswatum"Alma hits) Date Time Received by Iswne+we•^d Pmed Nie) Date Time <br /> I hereby authorize ATL to perform the work Send Report To ^ Bill To ! � Special Instructions/Comments <br /> Indicated below Ann 14I0 .5-Nr'A'1U atm a - CA'1I f4ftetD Ji4e.>t1I61S <br /> Project Mgr/Submitter <br /> bul C1syr _ h7-21-05' Co -SF�o2 17-- 300 <br /> Pmt Name Date Address.57 t gAyeft C X21 Address <br /> c �}t=1►ye_tk, state (/t zl City state Zip <br /> QA/QC <br /> Sampte/Retards-Archival&Disp9sal Circle or Add SPECIFY APPROPRIATE <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX Z RTHE ❑ <br /> receipt and records will be disposed f year after submittal of final report Requested ^ap~ O CT ❑ <br /> Storage Fees(applies when storage is requested) �� o ¢ < SWRCB ❑ <br /> e Sample $2 001 sample/mo(after 45 days) w <br /> Records $100 1 ATL workorder I mo(after 1 year) aim x Logcoda <br /> I LABBUSCSample <br /> E ONLY Description �m� _� Qo~ Qom Container(s) N OTHER <br /> Q m o a Q 2 Container(s) w <br /> E Lab No Sample I D 1 Location Date Time �^� Qp" �;�� yon 3� ��o�� TAT # Type REMARKS <br /> M <br /> - ) Nl W- I-TrRA 1v io fl' 2 L'� <br /> I <br /> I <br /> I <br /> 1 <br /> 1 <br /> I <br /> � F <br /> 1 <br /> I <br /> 1 <br /> I <br /> 1 { <br /> Overnl g ht Emergency Critical U ent Routine Preservatives <br /> •TAT starts 8 a m following day d TAT A= <24 hrB Next workda C= 2 Workda s D= 3 Workda s E=7 Workda s I I H=HCI N=HNO3 S=H2SO+ C=4 C <br /> samples received afte►3 p m <br /> Container Types T=Tube V=VOA L=Liter P-Pent J--Jar B=Tedlar I G=Glass P=Plastic M=Metal I Z=Zn(AC)� O=NaON TwNa:Sz03 <br /> nn�nrarr.• ••+�:._ _L........a Y— — M <br /> SAA— pi..L M o4..n.Mar <br />