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r cMW NOcIMo&PRE40RcON MI M IMiMi f M <br /> ILVFOR LABORATORY USE ONLY 0 <br /> vanced Technology Method of Transport Sample Condition Upon Receipt <br /> Laboratories Basch a DO # Walk in ❑ 1 COOLER TEMP C (2 6) 5 SEALED Y❑ N❑ <br /> Conner ❑ 2 CHILLED Y❑ N❑ 6 #OF SPLS MATCH COC Y❑ N D <br /> 1510E 33rd Street POA UPS ❑ <br /> Signal Hill CA 90807 FED EXP ❑ 3 HF_ADSPACE(VOA) Y❑ N❑ 7 PRESERVED YO N❑ <br /> (310)989-4045•FAX(310)989-4040 Logged By Date Time ATL ❑ 4 CONTAINER INTACT Y❑ N❑ 8 CONTR LOT# <br /> Client GEOCON ENVIRONMENTAL - SACRAMENTO Address 3235 Sunrise Blvd #6 TEL ( 916 1 852 9118 <br /> Attn 7 k� Sv h `.�,J i. /VV% a gnu Clly Rancho Cordova State CA Zip Code 95742 FAX { 916 1 852 9132 <br /> Project Name Project# Sampler (Pnnied Nam) (Signature) <br /> ►3rSr�rcy 1p , s� cyl+rj� 5 rfQo�cb �z —�-Q... .z W4!)4-J <br /> Rel;nq ed .md Pn N r la rp Received by Isgn■u.row Print.d N.m.> fAA, 1-L Date _/(b Time <br /> Relinquished by Is-9na.--d P.mr.e Ne ) Received by (sgmme aM aroma N. ) Date Time <br /> Relinquished by IWO t.Wd P.mr.d N. ) Received by (s.9—u.r w P—w Nmj Date Time <br /> I hereby authorize ATL to peitorm the work indicated below Send Report To Special tnstrucoons/Commenis <br /> Unless otherwise Project Mgr/Submeter Ann So Hit:. SJ M/z ErJJ Sze- rI <br /> requested all ' �f <br /> samples will be .,.r A 6 ''^'a k'g/l Date O-"1 0/ f 96 Co _ _�c OGS <br /> disposed 60 days P o Noma <br /> after receipt 1 Address +^ Q <br /> Scriaiure City State Zip <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circle or Add o CIRCLE APPROPRIATE Q A ( Q C <br /> (SUB CONTRACT) (SUB CONTRACT) (SUB A <br /> CONTRACT) � U � <br /> Analysis(es) o <br /> 7£sT TEST TEST Requested �� y~ ��, MATRIX Z O RTNE <br /> — Rwxa <br /> ATL# ATLs ATLr tO �� ED <br /> DATE DATE m m" y1 U o� .>� �d �]� Q Q WIP <br /> CLIENT I D CLIENT I D CLIENT I D m� �� `° V�' a� m PU r r j (Z. cc NAVY ❑ <br /> LAB USE ONLY i�� Qin" �° mar c� a�' h`" Container(s) <br /> CT <br /> T Batch# Sample Description ^o ryq� 0o b°� ^o �� �a �o `� o� ��' �` OTHER <br /> 9 t" NLU <br /> M Lab No Sample I D Date Time "°rye° gy "� m moo" o�¢ 3�o TAT # Type a REMARKS <br /> /✓1�J (, 1 Z a i L <br /> 4 V : r <br /> MI-J 9 ►�zS x x v <br /> I I I U <br /> v�- Z ?-<Z)0 ' I i I I 1 1 LI: 1 <br /> I I <br /> Sample A cniv&Disoosal Overnight Emeroen I Critical Ur ent _ outtne 'TAT starts B a m Preservatives <br /> �4 Laboratory Standarc TAT A= 24 hr 9 B. Next Workda C= 2 Workdays D= 3 Workda s E Workda s I following day if samples <br /> ❑ otne reserved aper 3 m t#Hci N=HNO, S=HzSO. C <br /> ❑ Rewrn To Container T pes T=Tube V=VOA L=Liter P-Pint J--Jar B=TedlarG- ass P=Plastic M=Metal Z=Zn(AC)- O=NaOH T=NauSzO, <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 />