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CHAIN OF CUSTODY RECORD Pa % Of <br /> FOR LABORATORY USE ONLY: <br /> Method of Transport 1 Samphs condition Upon Receipt <br /> Advanced Technology Client ❑ 1.CHILLED 3 Yip N❑ 4.SEALED YOJNO <br /> Laboratories P.O.#: ATL ❑/3275 Walnut Avenue / �, CA OverN fd 2.HEADSPACE(VOA) Y❑ N❑ 5.#OFSPLSMATCH000 YSignal Hill,CA 90755 Logged By. Dete: /' FEDFFFX ❑ <br /> (562)989-4045 • Fax(562)989-4040 Other: 3.CONTAINER INTACT Y❑ N❑ ' PRESERVED Y <br /> Client: GEOCON CONSULTANTS, INC. Address; 3160 Gold Valley Drive, Suite 800 rex ( 91 6 ) 852-9118 <br /> Attn: IA � T Cllr Rancho Cordova State CA ZlpCode 95742 FAx: ( 916 ) 852-9132 <br /> Sampler. P4plea Name) egne� <br /> Project Name: Project CIL p Jo� � EedLte; <br /> 'G2in 1'R W l+A.DS oCAz- 1 -�: Time- <br /> Relinquishedby:Ise••1• •) ��a Ertl Date: 2.jIrL Time: )}3O ReceNed by:(sb•°Iwty Ga •) FQyp�c t�L IL /�.��10 <br /> Date: ( Time ReMMUPy:lslr••w•••a Na I• N•m•1 ' I-d- �� * Time, u <br /> Relinquished ,s Pa ImTime. d 3 <br /> Relinqulshedby:(Sigmt •am Pam•a Nem• Date: Time: Received by:Islru•w...a Pnmm N.m•7 q <br /> V <br /> I hereby authorize ATL to perform the work Send Report To: Bill To: Special in etions/Ce mems: <br /> indicated below: Attn: F—•R61 Y Ti'1, Al Atm: <br /> Project Mgr/Submitter. C�f Cf t I I �i1 <br /> Co: Co: <br /> �LD I# <br /> P'l Neme Address Address <br /> SI nawre cia, State_Zi _ City State—Zip— APPROPRIATE Q A/ C <br /> CY <br /> Sample/Records Archival Disposal Analysis(es)imle or Add SPECIFMATRIX 0 RTNE <br /> Unless otherwise requested byy client,all samples will be disposed 45 days after Requested A CT— CT ❑ <br /> receipt and records will be disposed 1 year after submittal of final report. <br /> Storage Fees(applies when storage Is requested): > SWRCB ❑ <br /> •Sample :$2.00/sample/me(after 45days) PQ ZI <br /> •Records:$1.001 ATL workorder/me(after 1 year) a m�m"� W Logeoda <br /> 0 g Contalner(s) to <br /> I LAB USE ONLY: Sample Description �+°l �,a'�0rrlhaT Aeo oQp li a J=o ,3 W OTXER— <br /> T Batch ty g 0 v o`er Qo Qy rnr # Type a REMARKS <br /> MLab No. Sample I.D./Location Date Time gm g 5 3 0 3 <br /> /Loo2�3-�1 Gores .Z <br /> I�u�ia 1Gt'f � x . : G 1 MI'( C <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> o Preservatives: <br /> Overnight Emergency Critical O_ Urgent E=Routine <br /> •7A7 scads B a.m.following day if TAT:A= 24 hr B Next workda �= 2 Workda s – 3 Workda s 7 Workda s H=Hcl N=HNOa S=H:SO. C=4'C <br /> samples received after 3 p.m. <br /> Container Ty es: T=Tube V=VOA L=Liter P=Pint J_–Jar B=Tedlar G=Glass P=Plastic M=Metal Z=Zn(AC)r O=NaOH T=Na= r a <br /> _ nIC�Tlftfl�e..11� Vel Inlr1e�41n 1,�• _ <br />