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CHAIN OF CUSTODY RECORD Pg--A—of <br /> ` - FOR LABORATORY USE ONLY: <br /> Method of Transport Sample Condition Upon Receipt <br /> Advanced Technology }. i <br /> Client ❑ 1.CHILLED Ylp N❑ 4.SEALED Y N <br /> Laboratories P.o.# ATL ❑, <br /> MY <br /> Walnut Avenue y - CAOverN 2.HEAOSPACE(VOA) Y❑ NO 5.AOF SPLS MATCH COC YZN ❑ <br /> Sign I-Ti <br /> Signal ll, CA 90755 Logged By: Date: /�¢' FEDEX ❑ <br /> (562)989-4045 • Fax(562)989-4040 Other: 3.CONTAINER INTACT YO/NO 6.PRESERVED Y ❑ N <br /> Client: GEOCON CONSULTANTS, INC. Address: 3160 Gold Valley Drive, Suite 800TEL: ( 916 ) 852-9118 <br /> Attn: N Grc4 city Rancho Cordova State CA Zip Code 95742 FAX: ( 916 ) 852-9132 <br /> Project Name: Project#: Sampler: (Pn ted Name) (Signs <br /> S�i�l£Z-&( CZ <br /> S _ <br /> 'Cn2vrK.2 weans ocn�. <br /> Relinquished by:isiga:w P •) Date: Time: Received by:(sig..m 7 gad N.m.l -Da-re: Time: <br /> Ljlrz ( }3u � iy ' FzwG,< t/t;1tz. / 30 <br /> Relinquished s Pn m" Date: ( t Time Received by:(stg�.m.a and Prhtd N.m.) a /� Date:l/ Time- <br /> Relinquished by:(sigmw.a.,d Pnmed N.m.) Date: Time: Received by:(sigwumnnd Prtmd N.my ��. 1..� Date: Time: �35. <br /> 151Y <br /> I hereby authorize ATL to perform the work Send Report To: Bill To: Special In ctions/Co ments: <br /> indicated below: <br /> Project Mgr//Submitter: Attn: ��fi /i.Y rjs��A Atm: <br /> )US l+ rG�Enf t Z Co: Cc: + Cal Cr, � 1 <br /> i Pb, L r t <br /> Pri t Neme petrt <br /> Address Address <br /> Si nature Ci StateZlp_ City StateZlp_ <br /> Semple/Records-Archival&Disposal Circle or Add SPECIFY APPROPRIATE QA/QC <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) <br /> receipt and records will be disposed 1 year after submittal of final report. Requested •t MATRIX ZO RTME <br /> Storage Fees(applies when storage is requested): o CT ❑ <br /> •Sample :$2.00/sample/mo(after 45 days) �� a <br /> •Records:$1.00/ATL workorder/mo(after 1 year) A em m�\mti� >l� QQ�e ¢ SWRCB ❑ <br /> I LAB USE ONLY: a r W Logeode— <br /> T Batch#: Sample Description am« mm �� _� o me° e° A o c Containers) W <br /> Q . 6 . Q 4 P 2 W OTHER_ <br /> M Lab No. Sample l.D./Location Date Time 0�ry ��0&m�m0^m J yo �o¢o3e TAT # Type a REMARKS <br /> /20o2�3-GJ CSM -� 'Iv,Irr. IGr�' � x . - G t MIT C <br /> , <br /> I <br /> • <br /> TAT starts a a.m.following day if TAT: A= Overnight B Emergency O_ Critical �_ Urgent E_ Routine Preservatives: <br /> samples received after 3 p.m. 24 hr Next Workda - 2 Workda s - 3 Workda s --L7 Workdays] H=HcI N=HNO. S=HgSO. C=4'C <br /> ContainerT pes: T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOH T=Naz,S.O. <br /> wr.r•e,.,ut,mend vepnw to fnider. Pink to submitter. <br />