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CHAIN OF CUSTODY RECORD Pg I of <br /> I� FOR LABORATORY USE ONLY <br /> Advanced Technology Method of Transport Sample Condition upon Receipt <br /> Client ❑ 1 CHILLED Y�N El 4 SEALED Y El0,6 <br /> E PO# ATL ❑ O-i]o� <br /> 3275 Walnut Avenue CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N p 5 #OF SPLS MATCH COC Y ❑ <br /> Signal Hill,CA 90755 Logged By ��t/ Date FEDEX <br /> (562)989-4045 • Fax (562)989-4040 Other 3 CONTAINER INTACT y,E" N p ti PRESERVED Y ❑ <br /> I <br /> Chen &7��0_aN Addressf� Rz5o R TEL ( L7) 371 — cro <br /> Attn kW City Liv w..o��� State Zip Code ^� FAX( // <br /> Project Name Cw Project# I I Sampler (Printed Name) ` (Signature) <br /> Relinquished by tsWaI and I'Med NaI Date 3 , PWd Nm6 p ra (Date / j3 Time// a <br /> Relinquished by (9igwweaMPnntedNa ) Date Time Received by (signalumand PnntedNorm) (Date Time Ob <br /> Relinquished by (SigrsstueaWPnnt•dName) Date E �jTime Received by(SignaIandPnIedName) (Date Time <br /> hereby authorize ATL to rfoma the work Send Report To 1 Bill To S eclat Instructions/Commenis <br /> indicated below OG + 13 Wil`j}t- A <br /> Project Mg'r 1 ;m�l� Ann l � N Ann � 3 aT>*�X� �s J <br /> co �4CL C/'�T „ oZQ� t�w.rT a F v.5 �iLl L <br /> Print Name I Date Address Address 7� �1 <br /> s%i nature Ci State Zip City State Zip lir RFti.,,L4j CvolL <br /> Sam i rle/Records-Archtval&Di posalCircle or Add SPECIFY APPROPRIATE QA/0C_ <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysts{es} MATRIX RTNI: <br /> receipt and records will be disposed 1 year atter submittal of anal report Requested iKp <br /> Storage Fees(applies when storage is requested) <br /> •Sample $2 00/sample/mo(after 45 days) <br /> •Records $1 00/ATL workorder/mo(after 1 year) �°+ `m9 g� ��Q � IlLogcode_ <br /> 1 LAB USE ONLY g r o� Container(s) to <br /> T Batch# Sample Description e° Qpm c� m� �o �e oe° 07 _° mss' uu OTHER <br /> E �� ` rr <br /> M Lab No Sample ! D /Location Date Time �� �ti� $ �0 3� czQ S,P TAT # Type a REMARKS <br /> I -get <br /> — I 1301 3 vIC�� <br /> 3 <br /> - U� 5 lzJ3 <br /> G <br /> 5-D <br /> J <br /> OC g <br /> Vic <br /> I Overnight Emergency al Urgent Routine Preservatives <br /> •TAT starts falter 3 p day if TAT AT $ C= Q= E- H=HCI N=HNO3 Z04 C=4 C <br /> <_24 Fir Next Workda kite s 3 Workda s 7 Workda s <br /> samples r after 3 p m <br /> Container T= e V=VOA L=titer P=Pin J=Jar B=.Tedlar ,, G=Glass P=Plastic M=Metal Z=Zn(AC)Z O=Na T=NazSz03 <br />