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H o ® c i <br /> FOR LABORATORY USE ONLY <br /> Advanced Technology Method of Transport Sample Condition Upon Receipt <br /> Laboratories Batch# D O # Walk in 01 COOLER TEMP C—(26) 5 SEALED Y❑ N❑ <br /> 1510E 33rd Street Courier 2 CHILLED Y❑ N1 6 #OF SPLS MATCH COC Y j N❑ <br /> PO# UPS ❑ <br /> Signal Hill,CA 90807 i FED EXP ❑ 3 HEADSPACE(VOA) YE) N NO 7 PRESERVED Y❑ N❑ <br /> (310)989-4045•FAX(310)989-4040 Logged By DateQ-:a 2z' e V ATL ❑ 4 CONTAINER INTACT Yo) N❑ 8 CONTR LOT# <br /> Client <br />� GEOCON ENVIRONMENTAL - SACRAMENM Adoress 3235 Sunrise Blvd x6 TEL ( 916 ] 852 9118 <br /> Alm /Cdr City Rancho Cordova State CA Zip Code 742 FAX( 916 ] 852 9 132 <br /> Project Ngme - // Project# am (PnntedNarm) 5 Ivr9) <br /> _�� D4 .e it <br /> Relinquished by sena.. wee.aN—) Received by (senor.endPnnr.d .) Date -t t� 1Ll 0_ eq/ _ Tlme t <br /> Relinquished by (senwm.,od P.w.d a.m.) Received by Isynetx.end Primed Nem.) bate Trme l <br /> Relinquished by (Sen*wi.end Prmi.d Nem.) Received by IS�gnetx.and Printed Nemo) {late Time <br /> I hereby authorize ATL to perform the work sndioated below Send Report To Special Instrumons/Comments <br /> Unless otherwise Project Mgr/Submitter Arm <br /> requestedall �r 1P � Co <br /> samples will l be -�✓ Date r� <br /> disposed 60 days Prmt Narns <br /> Address <br /> after receipt <br /> Signature City State Zip <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Cucleor Add c, CIRCLE APPROPRIATE QA / Q <br /> (SUB CONTRACT) (SUB CONTAACTt ;SUB CONTRACT) Analysis(es) �v� Q?� MATRiX Z <br /> TEST TEST TEST Requessed �y \a h� e O RTNE ❑ <br /> RWQCB ❑ <br /> ATL s ATL x ATL x g �0 o° G^ J h l'- <br /> DATE DATE DATEQ WIP <br /> Q ❑ <br /> CLIENT I D CLIENT 10 CLIENT 10 m�� �ma =° �V�4-}~�¢m V �v= Q NAY-LU c <br /> ❑ <br /> LAB USE ONLY Sample Description �' � � m Q� Q?P r` �U �O =O Contamer(s) () OTHER <br /> T Batch# o "� roo ao ^o ti �Q �° �4 Q 4 w <br /> E o 0 rz 9 '� <br /> 2 tz <br /> lM Lab No Sample I D Date Time �o"� �00� p �tiy 0y e �O" O�� �,� oe .e Q TAT # Type a REMARKS <br /> 2 - DOI <br /> � I <br /> r <br /> i <br /> I � <br /> � t <br /> Sample Archnre]Disposai Overnight Emergency CrAlcai Urgent Rovune •TAT start-Bam Preservatives <br /> 0 Laboratory Smnoard TAT A= 24 hr 8= Neta workday C` 2 WDricdays, D= 3 Workda s E=7 Workdays <br /> Eoliowngday rl samptes <br /> © Omer recenred Att.r 3 m H=Hcl N=HNO, S=H.SO. C=4 C <br /> ❑ Return To Container Types T=Tube V=VOA L=Leer P=Pmt J--Jar B=Tedlar G=Glass P-Piastic M=tvlelal I Z=Zn(AC)- O=NaOH T=N&S-03 <br /> " <br /> SIO 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Green to organic Yeflow to inorganic Pink to Biology Gold to submitter <br />