COB0W2LCW - Laserfiche WebLink

Home Browse Search

,t,2ceAnalytical. CHAIN-OF-CUSTODY Analytical Request Document Chain-of-Custody is a LEGAL DOCUMENT - Complete all relevent fields LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or MIA Log-in Number Here SHADED AREAS are for LAB USE ONLY Company: ATC/ Atlas, San Ramon Billing Information: #30.0.1,1-M rii•V‘tb"ALL -/ I-c Z 1 i-i co-< Address: 2001 Crow Canyon Rd. Suite 210. San Ramon. CA. 94583 ,/ wt. Cavvv" ccr rt y cvl - - — san tgail, c .. - Container Preservative Type " Lab Project Manager: I I 1 1 1 Report To: Matt Livingston, Michelle Berube Email To: matt tmagston4cneaaa a ..,..', mchaile ae,be43toneatlas c.c.% •• Preservative Types: (I) nitric acid, (2) sulfuric acid, (3) hydrochio ic acid, (4) sodium hydroxide, (5) onc acetate, (6) methanol, (7) sodium bisulfate, (8) Sodium thiosulfate, (9) hexane, (A) ascorbic acid, (8) ammonium sulfate, IC) ammonium hydroxide, (D) TSP, (U) Unpreserved,(0) Other Copy To: michelle.berube@oneatlas.com Site Collection Info/Address: Bonnie Plants, Linden CA Analyses Lab Profile/Line: Customer Project Name/Number: Bonnie Plants State: County/City: Time Zone Collected: CA/Linden (1,413T[ )MT( (CT) JET soil DRO/ORO- CA soil GRO- CA Title 22 Metals soil VOCs 8260 i 4, .. Lab Sample Receipt Checklist: Custody Seals Present/intact ' NA Custody Signatures Present ' NA collector Signature Present 1 NA Bottles Intact ; NA Correct Bottles 5! NA Sufficient Volume Samples Received on Ice N NA N NA VOA - Heacispace Acceptable Y N NA USDA Regulated Soils Y N NA Samples in Holding Time Y N NA Residual Chlorine Present Y N NA :1 Strips: Phone:510-362-5253 Email: matt.iivingstononeatias corn Site/Facility ID #: Compliance Monitoring? ( ] Yes [ : No Collected By (print): Michelle Berube Purchase Order #: Quote #: OW PWS ID #: OW Location Code: Collecte. B signature): Turnaround Date Required: Immediately Packed on Ice: 1 irf Yes 1 ] No - ple Disposal: I I Dispose as appropriate I I Return I (Archive:I Rush: I ] Same Day [ ] Next Day I 2 Day 1 ] 3 Day [ ] 4 Day 4,r] 5 Day Field Filtered (if applicable). [ ] Yes kol No ; sample pH Acceptable Y r NA pH Strips: ( (Hold. Analysis: (Expedite Charges Apply) Sulfide Pre.ent Y t: NA Lead Acetate Strips: ' Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW), Product (P), Soil/Solid (SL), Oil (DL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (01) , , LAB USE ONLY: Lab Sample L14./.5-2-2-5-1 Customer Sample ID Matrix • Comp / Grab Collected (or Composite Start) Composite Eno Res Cl # of Ctns _ Date Time _ Date Time JCS-1 Soil Comp 1148 1/14/22 1148 1/14/22 2 >< <>.<><., —c-( - Customer Remarks / Special Conditions / Possible Hazards: Type of Ice t.--Jsec y None SHORT HOLDS PRESENT (<72 hours): Y N N/A Lab Sample Temperature Info: Temp Blank Received: Y N NA Therm IN: Packing Material Used: Lab Tracking #: 5)11 /11131' )'). Coder 1 Temp Upon Receipt: oC Radchem sample(s) screened (<500 cpm): Y N NA Sart... received via: DEX UPS Client Courier Pace Courier Cooler 1 Therm Corr. Factor: oC Cooler 1 Corrected Temp: oC Relin. uished . • • puny: (Signature) Date/Time: Received by/Company: ignature) Date/Time: B188 - Comments: l— - Relinqui ed by/Company: (Signature) Date/Time: Received by/Company: (Signature) Date/Time: Acctnum: Template: Prelogin: N NA . lank Received: i) Me0H TSP Other 1 Relinquished by/Company: (Signature) Date/Time: Received by/Company: (Si nature) (\C-c------ J/ Date/Time: , . Vd,d- (i• pZ0 PM: PB: Non Conformance(s): Page: YES / NO of _