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-'dvanced Technology FOR LABORATORY USE ONLY IRW <br /> Method of Transport Sample Condition Upon Receipt <br /> Laboratories Batch# DO a Walk 1n ❑ 1 COOLER TEMP C-(26) 5 SEALED Y❑ N❑ <br /> Courier ❑ 2 CHILLED Y❑ N❑ 6 #OF SPLS MATCH COC YO N❑ <br /> 1510 E 33rd Street PO4; UPS ❑ <br /> Signal Hill,CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) Y❑ N❑ 7 PRESERVED Y❑ N❑ <br /> (310)9894045•FAX(310)9894040 Logged By Date Time ATL ❑ 4 CONTAINER INTACT Y❑ N❑ B CONTR LOT# <br /> Client GEOCON ENVIRONMENTAL. - SACRAMENTO Address 3235 Sunrise Blvd #6 TEL ( 916 j 852 9 318 <br /> Attn 11, t't/0,P-5 City Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852 9132 <br /> Pro)ect Name � 1p ! Project# Sjpp—06_l g Sampler (P Name) (signature) <br /> 4 . 1Relinquished .m. - caved by rs�g-t. .nil y-f 1h Date Trme <br /> t� <br /> Relinquished by (SW an—d ecerved by (swgmx- r Q Date 91 <br /> Time , <br /> Relinquished by tswm..rrdP.,"dN .) Received by rsg..e..WP..t.dFl.m.) Date Ttme <br /> I hereby authorize ATL to peftrm the work indicated below Send Repp�t To Special lnstructionsiComments <br /> Unless otherwise Project Mgr/Submitter Ann 'c(:� <br /> requested all /� 1 <br /> samples will be !� � �19 f/ Date 7 1 7rr- Co <br /> disposed 60ys Prot Name !fJ� `/� Address <br /> after receipt ��//1{j 1 ,( <br /> Sgna[ure City State Zr <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add o CIRCLE APPROPRIATE 0 A l <br /> (SUB CONTRACT) (SUB CONTRACT) (SUB CONTRACT( Analy5i5(e5) �Q� mc' MATRIX <br /> TEST TEST TEST Requested �� `� ` h� O RTNE ❑ <br /> ATL a ATL s ATL s a°� �� me ��� -F U� °o°� .0" J� `<uQ RWGICB ❑ <br /> DATE DATE DATE F° 44 �m g, VO V oC J� O 3� Q Q WIP ❑ <br /> CLIENT t D CLIENT 10 CLIENT 10 <br /> Q NAVY ❑ <br /> I LAB USE ONLY ` Qmti rye° m Container(s) w CT <br /> T Sample Description o °� o 0 0 �a� a� o o" ?� �` OTHER <br /> Balch# m� °a om wry, ery `o y mow¢ �Q w <br /> Lab No Sample i D Date Time �o eoti w°�� �' �ryh $" e m �o` o. �� Qe.� w o TAT # Type a REMARKS <br /> dL r <br /> C,02- V - <br /> V Jv) <br /> I r <br /> /N_ i 1050 I 1 <br /> L))\'-I- Yo <br /> 1 <br /> Sample ArChtvelDisposa I TAT <br /> Sample starts 8m <br /> 0 Laboratory Standard TAT A= Overnlgnt B- Emergency C_ICritical I D_ Urgent E_ Routine I followngdayMsamples Preservatives <br /> ❑ other s 24 hr I Nex+workda .2 Workdays 3 Workdays r Workoays recsryH=Hcl N=HNO, S=H.SO, C=4 C <br /> ❑ Rerurn To Container T Des T=Tube V=VOA L=Ltter P=Pint imiar B=Tedl21r G=Glass P=Plasttc M=Metal Z=Zn(AG) O=NaOH T=Na S O, <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 />