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CHAIN OF CUSTODY RECORD Pg I of _ I <br /> FOR LABORATORY USE ONLY: <br /> Method of Transport Sample Condition Upon Receipt <br /> Advanced Technology Client ❑ 1.CHILLED ` Y I/N❑ 4.SEALED Y ❑ N <br /> Laboratories P.°# ATL ❑ <br /> NA / <br /> Sign Walnut Avenue CA FEDEX N 2.HEADSPACE(VOA) Y❑ N❑ 5.#OFSPLSMATCH000 YhJ N ❑ <br /> Signal Hill,CA 90755 Logged By: Data: 01914- FEDFJC ❑ 1 <br /> (562)989-4045 • Fax(562)989-4040 Other: 3.CONTAINER INTACT Y/N❑ 6.PRESERVED Y ❑ N ) <br /> Client: GEOCON CONSULTANTS, INC. Address: 3160 Gold Valley Drive, Suite 800 TEL: ( 916 ) 852-9118 <br /> Attn: JoSra `i2 city Rancho Cordova State CA Zip Code 95742 Fax: ( 91 6 ) 852-9132 <br /> Project Name: Project#:StNSz-tSampler: P`inted Name) isi tare <br /> �tRM 2pS Awo Vv 7(o-UZ Ja ihcc �— <br /> Relinquished by:Is P ad I Date: Time: Received b s' re a Pani Nama� <br /> rry ti err 7 !�; ,t °!dJ Y f re o gP= r'2 Date: ,. li- r Z Time: w <br /> Relinis a Date: 118 Time: Received by:lSla.W.and Pentad!N..l G Date: I/I 12 Time: jl <br /> Relinquished by:(sgnawraand Pdmadn.ma7 Date: Time: Received by:(Siaaawna and Primed Nama) Date: ! �c��y Time: �/a'✓ <br /> 1 hereby authorize ATL to perform the work Send Report To: Bill To: Special In ctions/Co ments: <br /> Indicated below: <br /> Project Mgr/Submitter: Atm: Ann' <br /> Jc3A �w94T- 1 Iv tZcc: Co: <br /> falint4igume Date Address Address <br /> si nature Ci State—zip City State Zip_ <br /> Sample/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) Z <br /> receipt and records will be disposed 1 year after submittal of final report. - Requested MATRIX 0 RTNE <br /> Storage Fees(applies when storage is requested): 0 F CT ❑ <br /> •Sample :$2.00/sample/mo(after 45 days) Y < <br /> •Records:$1.00/ATL workorder/mo(after 1 year) ,� 1C� ,�uQ C, > SWRCB ❑ <br /> I LAB USE ONLY: `Plc aomo�� 3P Container(s) W Logcode_ <br /> T Batch#: Sample Description a° �m ma �, ox oe e =o ) w OTHER <br /> J h <br /> M Lab No. Sample I.D./Location Date Time m&� ��� �� 0^m yo` ,Q oe°3e TAT # Type aI REMARKS <br /> 1 1 XXX C t NIT G *c.A Gr <br /> � N <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> , <br /> i <br /> i <br /> Overnight Emergency Crcal Urgent Routine Preservatives: <br /> samples received atter 3 p.m. <br /> • TAT starts a a.m.following day if TAT: A= 24 hr B Next Workda C= 2 Workda s D= 3 Workdays E=7 Workdays H=Hcl N=HNO. S=H:SO, 0=4'C <br /> Container Types: T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AC)z O=NaOH T=Na2S.0, <br /> n,nrn,n,—1—. —1—-Ath rnnn, Vnllnav to fnider Pink to Submitter. <br />