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I ! � <br /> CHAT 1N 1 OF CUSTODY RECORD Pg-t-of <br />� ®4 1 I1 �i FOR LABORATORY USE ONLY <br /> Advanced Technology i 1 Method of Transport y NO 4 SEALED Y N Sample ondiEion Upon Receipt <br /> Client ❑ t CHILLED V Y <br /> Laboratories P o# � � <br /> ATL ❑ P <br /> 3275 Walnut Avenue I CA OverN ❑ 2 HEADSPACE(VOA) Y❑ Ne 5 #OF SPLS MATCH COC Yp-fl ❑ <br /> Signal Hill,CA 90807 Logged By 0J.4 J, Date 100!�(Z�L— FEDEX (1 0 <br /> (562)989-4045 • Fax(562)989-4040 �� Other U!a" 3 CONTAINER INTACT >�f N❑ 6 PRESERVED, Y ❑ N <br /> Client C-SoaofjI Address 7J5YJ ��5�� { TEL (12-5 1 371-,$904 <br /> Attn rAO<Tt 404" city IlLx v fi Q-ftp-F State CA Zip coda &5o FAX /5 <br /> nn <br /> Project Name V-AW—%k rv1AR.��,s Project#S� II ���-� ( Sampler ted Name) (S)gnature) <br /> ��� <br /> Relinquished by (svwwaand PnwedNamerfhGOOT Date tdwqs I�Time X730 Received by isgretureandPmtedName)• 7 v Date 3 7 Time �(- <br /> Relinquished by (sig www and Pmnad rel Date II I[Time Received by is,gnatum and Pmted Name) Date J Time a <br /> Relinquished by (sxy,eture and Pnnted Namai Date JITime Received by isignatarre end Ported Name) , Date Time <br /> I hereby authorize ATL to perform the work Send Report To iI Ii Bill To �f Special InstructionstCComme�n{ts N1 �j <br /> indicated below Atte /�LIT� /�J1//CG II- l - �iTl�a r o—Am o 4' alt j 414—j (A N l `r��m�� <br /> Project Mgr/Submitter I ` <br /> � - Co cameo Il ! II Co <br /> Pnnt Name DateAddress GyG�l�'ta LEll II Address <br /> Siazure city State h Zi11 �11 city State Zip <br /> 1, Circle or Add SPECIFY APPROPRIATEA�C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX Z RTNE ❑ <br /> receipt and records will be disposed t year after submittal of final report I Requested O CT ❑ <br /> Storage Fees(applies when storage is requested) ¢ SI <br /> •Sample $2 001 sample/mo(after 45 days) �II �A. x ham¢ e > SVYRt:B ❑ <br /> •Records $100/ATL workorder/mo(after t year) 1' f 9 <br /> LAB <br /> Batt hONLY <br /> Sample Description j �{ Qm �� o�2P ogee°��°� Q � �� contamer(s) OTHER <br /> . �' C <br /> E STCO <br /> Lab No Sample I D /Location Date Time ` �� ry� ��� ^m om o� e�J TAT # T e a REMARKS <br /> M p It I � � �' s1 c� � � <br /> Dry I <br /> - dp v- ; v P <br /> t <br /> - <br /> /W W-5 <br /> ' I .i <br /> r — AA <br /> t W —, it ✓ [� <br /> 31VI� <br /> o44 - oo Ow-Z P, 3 <br /> Overnight , Emergency I Critical Urgent Routine Preservatives <br /> • TAT starts 8 a m following day <br /> if A= <24 hr Next workda C= 2 orkda s Q= 3 Workda s E=7 Workda s H=Hcl N=HNO3 -H2SO4 C=4 C <br /> samples re Is <br /> after S p m Container Types T=Tube V=VOA L-41-iter P— J-Jar B=Tedlar : G=Glass P=Plastic M=Metal Z=Zn(AC)2 0= T=Na2S2O9 <br /> RIB W h re ello der, sub M <br />