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FOR LABORATORY USE ONLY <br /> A vanced Technology Method of Transport Sample Condition upon Receipt <br /> Laboratories Batch# DO # Walk in ❑ 1 COOLER TEMP C_(26) 5 SEALED Y❑ N❑ <br /> Couner ❑ 2 CHILLED Y[D N❑ 6 #OF SPLS MATCH COC Y❑ NO <br /> 1510E 33rd Street p o sx UPS ❑ <br /> Signal Hill,CA 90$07 FED EXP ❑ 3 HFADSPACE(VOA) Y❑ N❑ 7 PRESERVED YO N❑ <br /> (310)9894045 e FAX(3!0)9894040 Logged By Date Time ATL ❑ 4 CONTAINER INTACT Y❑ N❑ 8 CONTR LOT# <br /> Client GEOC N ENVIRONMENTAL- SACRAMENTO Address 3235 Sunrise BIVd #6 TEL j 916 } 852 9118 <br /> Ann �rc�[ City Rancho Cordova State CA Zip Code 95742 FAX i 916 } 852 9132 <br /> Protect Name Sj� Project# g Sampler <br /> hell i b i iniad } r� Received by iSognenre mtl Printed None) J Date tJ Time <br /> Relinquished by (stgo.e,te.nd Printed Nerne, Received by (sgnwa.. d Print.d m.) y .y ate 6 Time <br /> n. <br /> %inquished by (stgn.nand Prmt.d Nemo) Received by ISye.e...nd Printed N Date D Time <br /> i <br /> I hereby authorize ATL to perform the work indicated below iSend Report To Speaal nsirucnons/Comments <br /> Unless otherwise Project Mgr/Submitter Ann C7— s '� <br /> requested all <br /> samples will be Print Name Date r _ Cc TI '7 OMT-415S 06l q 6�, T&-z-0disposed 60 days <br /> after receipt Address <br /> Signature City State Zips` <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add v x CIRCLE APPROPRIATEQA / QC <br /> (SUB CONTRACT) {SUS CONTRACT) (SUB CONTRACT) Analysis(es} <br /> TEST TEST TEST Requested aa"e �� �y� _� o MATRIX z0 RINE ❑ <br /> RWOCIB <br /> ATL r ATLa ATL. a� @ v° Qo�,pJ �e WIP ❑ <br /> DATE DATE DATE eR� gym" y� UO U o J v Q, <br /> CLIENT I D <br /> CLIENT I D CLIENT 1 D � y ° ��� °m bo �v Cr <br /> Cr NACT ❑ <br /> 4,'� ` fJ `� a C v P Q' <br /> I LAB USE ONLY �ro �" a� v o e1 o a�' 3 Containers) <br /> T Batch # Sample Description o` mo poi ^� �QZ hQ1 �" O� Gjpv�Q � �� OTHER <br /> M Lab No Sample I D Date Time �� t, nom ry�y �"0"gyp` m °v o 3" oma=e s�¢�Q� TA's # Type a REMARKS <br /> 12-51 ' 1 HL-1-26- 10 /10 4 <br /> P)5 I fi <br /> 3 i�G- 30 ,f <br /> w-a6 - b <br /> 005 <br /> UU <br /> Mw-�- GO I <br /> ! I JFF <br /> { l <br /> i l l I I I ! : E ! <br /> SampleArpisveL��sposal Overnt ht Emergency ' Critical Ur ent Routine 'TAT starts8am Preservatives <br /> ID Laboratory Sranaara TAT A= < 24 hr g a= Next workda l C-12 Workdays D= 3 Workdays E=7 Workdays TOBfBNBd Otis►3llowing day 11 5mp�s H=Hcl N=HNO S=H SO. C=4 C <br /> CJ Other <br /> ❑ Return To Container T pes T=Tube V=VOA L=Lrte, P=pint J=.lar B=Tedlar G=Glass P=Plastic M=Metal Z=Zn(AC) O=NaOH T=Na.S--&� <br /> $10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Green to organic Yellow to inorganic Pink to Biology Gold to submitter <br />