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s !H� O1 D)MECMIQ M M <br /> A anted Technoio y FOR LABORATORY USE ONLY <br /> S Method of Transport Sample Condition Upon Receipt <br /> Laboratories Logged By Ll. Date to. 'Xme Walk In ❑ 1 COOLERTEMP C (2-6) 5 SEALED Y❑ N❑ <br /> Courier 2 CHILLED YVJ NO 6 :OF SPLS MATCH COC y N❑ <br /> 1510 E 33rd Street Batch# D 0 # UPS D <br /> Signal HW,CA 90807 FED EXP © S HEADSPACE(VOA) YO N❑ 7 PRESERVED Y❑ N❑ <br /> (310)989-4045 a FAX(3 f 0)989-4040 P 0 # ATL © 4 CONTAINER INTACT Y V NO 8 CONTR LOT# <br /> Client GEOCON ENVIRQNMENTAL- SACRAMENTO Address 3235 Sunrise Blvd #6 TEL ( 916 ) 652 9118 <br /> Ann �? `r ! City Rancho Cordova state CA Zip Code 95742 FAX( 916 ) 852 9 132--,, <br /> Project Name y Project# Sampler nerdNarm) (SgnaWT!> <br /> ct- � ' , <br /> r� <br /> Relinquished by ( paw) %Cln. <br /> calved by Isgw.-o Ar.a� w*. I f Date r�� <br /> � '],C` �Ime <br /> g,n <br /> Relinquished by (sgnanaaandP-"o 1 1. 7 Received by 1sh..Wda,.e.dNama) Date c .Time <br /> Relinquished by (Smnak-e and ir.*.e Nam.) Received by (sia..a—d ft w Nmm) ( /t Dare ZL�^ Time <br /> I hereby authorize ATL to perform the work Indicated below Send Report To Special Instruciions/Comments <br /> Unless otherwise Project Mgr/Submitter Arm <br /> requested all <br /> samples will be Date f Co <br /> disposed 45 days Prmt Name n <br /> City <br /> after receipt CAddress <br /> sgna,ure lty StateZIpSHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add 0 CIRCLE APPROPRIATE A 1 C <br /> (SUB CONTRACT) (SUB CONTRACTi (SUB CONTRACT) Analysis(esj U� ?� <br /> r, my o MATRIX z RTNE ❑ <br /> TEST TEST TEST Requested m"aa�UUP �`�� 2p O O RWQCB ❑ <br /> ATL a ATL a ATL a a� 0 <br /> J � H <br /> DATE DATE DATEc �y� NAVY WIP CD <br /> CLIENT I D CLIENT 10 CLIENT 10 go &� ` q �� P �1� �Q W CT <br /> I LAB USE ONLY Sample Description :ro amy �� m a asP r`:� ^ �o ov 3 2�, �� <br /> container(s) OTHER <br /> T Batch # 0 4� omo y.° ti h ;° o ��Q �Q a: <br /> E Lab No Sample I D Date Time �^°�oti� �o� � o a m moo" Q. �,� a¢= Q 3¢ 0 TAT # Type a REMARKS <br /> M <br /> 13" 5 � <br /> Oilv' t� <br /> all ni� <br /> D , i <br /> i l <br /> i <br /> , <br /> I ` <br /> f <br /> I <br /> I � <br /> I I I I I <br /> SampleArchrysDlsposal Overnight Emergency Critical Urgent Rautlne •TAwingday"s Preservatives <br /> ❑ Laboratory Standard TAT A= l 24 hr B` Next workday C` 2 Workda s I B= 3 Workda s E=17 Workdays ir.ned efts 35 m'p H=HcI N=HNO3 S=H2SO+ Cao C <br /> ❑ Other <br /> 0 Return Ta Container T pes T=Tube V=VOA L=Liter P=F Jt.lar B=Tedlar G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOIH T=Na.Sra <br /> •$10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to folder Pink to submitter <br />