Laserfiche WebLink
"A vanced Technology FOR LABORATORY USE ONLY Sample Condinon Upon n Receipt <br /> Method of Transport <br /> Laboratories Batch# DO # Walk in ❑ 1 COOLER TEMP C-(26) 5 SEALED Y❑ NO <br /> Courier ] 2 CHILLED Y`� N❑ 6 #OF SPLS MATCH COC )A N❑ <br /> 1510 E 33rd Street P 0# UPS ��j <br /> Signal Hill,CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) Y❑ N❑ 7 PRESERVED YD N❑ <br /> (310)98914045• FAX(310)989-4040 Logged By Date !� rme ATL ❑ 4 CONTAINER INTACT Yy NO B CONTR LOT# <br /> Client GEOCON ENVIRONMENTAL - SACRAMEN Address 3235 Sunrise Blvd #6 TEL ( 916 } 852 91 1 8 <br /> Attn 'ZI,CT-- VJOAL , city Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852 9132 <br /> Project Name Project# Sampler ^(PnmeaName) (sig <br /> Relinquished by (sgnaaue `L (( {1 y tr Recel Ved by iSm9mme end Rinsed Neme r d t� -�� Date 1 til Timefff <br /> ((p� <br /> Relinquished by Isgn.e,r.and Pnrned N �/1V ec ed by Date G� (� Time �, <br /> Relinquishedby Isgn.ene a d Rmisd Nemei Received by tsgnaa..end Rimed N 1� iJ 1WDate t Time <br /> I hereby authorize ATL to perform the work indicated below Send ReportTo Speaal Instrumons/Comments L <br /> Unless otherwise Project Mgr/Sub mitter Ann aj�-� S,':JL�2— <br /> requested all <br /> samples will be Date co <br /> disposed 60 days PrirnName <br /> after receipt Address <br /> Signature City State Zip <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add u CIRCLE APPROPRIATE A / <br /> (SUB CONTRACT_ (SUB CONTRACT} (SUB CONTRACT) AnaYysis(es} 0 MATRIX zRTNE <br /> Rei 'L <br /> ❑ <br /> TEST TEST TEST Reted <br /> T' aro Uva IF u 41.�� C$o� wry JO Q' RWOCB ❑ <br /> ATL s ATL• ATL k �° 4 60, O O � Q WIP ❑ <br /> DATE DATE DATE °�� yRu fie° ��� O m o v v �3 kid <br /> c .t o NAVY ❑ <br /> CLIENT l D CLIENT F D CLIENT I D m C� �� y C <br /> tum 7 a� Atue w CT <br /> I LAB USE ONLY Sample Description :° :° � m= Qs �° 3 k� Contarner(s) to o7liER <br /> T Batch# p p a y° cup W <br /> E Lab N a Sample le I Q Date TI m e �o�o�ory�o�om�o ry�ryh�ry 0���y�p m� .� �o� o.� �� oQ.Q s,Q�d TAT # Type a REMARKS <br /> M I <br /> I MW - 10 1 X I I E V 0 <br /> UJ -Q low G <br /> o OW-9 tow I X t,G <br /> W ,4 t I l X I r <br /> �s EX1 I <br /> I L 6 <br /> q 1 <br /> q �- �I <br /> cko <br /> Sample ArchiveiDisoosa[ (Overnight Emergency Critical Urgent Routine •TAT startst3em Preservatives I <br /> ❑ Laboratory Stannard TAT A= B-I^ C= 2 Workdays D= 3 Workda s E=7 Workda 5 toliowngday k samples <br /> ❑ Other I_24 hr Next workdav, received attar 3 m H=He! N=HNO, S=H-SO. C=4 C <br /> ❑ Return To Container T Des T=Tube V=VOA L-Liter P=Pint ,f-.jar B=Tedlar G=Glass P=Plastic M=Metal Z�Zn(AC)z O=NaOH i=Na S O� <br /> '$to 00 FEE PER HAZARDOUS SAM-LE DISPOSAL DISTRIBUTION White with reoori Green to organic Yellow to inorganic Pink to Biology Gold to submitter <br />