Laserfiche WebLink
`APPA"dvurtceclTech►rology CHAIN OF CUSTODY HECORD NQ. A 4 8 0 ' Ehereby autFwnzeATt wo <br /> to perform[he rkrndicaoedbelow <br /> LaboratoriesFOR LABORATORY USE ONLY Unless otherwise Project Mgr/Submitter Pg of <br /> Batch a Logged By requested all Date �3 LP <br /> 1500 E 33rd Street Secured ❑ Y ❑ N Date samples will be int Name <br /> Signal Hill,CA 90807 disposed 30 days <br /> (310)989-4045 • FAX(310)989-4040 Location after receipt <br /> sagnunra <br /> ClientrC1tz__J__S.C_Vy�, <br /> 23,S fUYlY1� t31vc� TEL {c11Co ) 8S2-tet t l8 <br /> Gco( rn O(-CICN/C,. State pk.— Zip Code g15_4(4 FAX( ct1Lo} )?52-- 91 -!>Z- <br /> Project <br /> ZProject Nameiuoq SblAln S S.}y-P-e—+ Project# Sampler (Printed Name) (Sgnaturel <br /> Relingwshad by (sipnaw.anearuu.dH.m. r. R eivedhy ts+waa...ndPr.r.eNam.) Date 3 S Time <br /> Relinquished by sod wnr.d Nr ) Received by t&9mk...ww Amwd sem.) Date Time <br /> Relinquished by .a PwAw rrem.) Received by tayrae..and artiad"e .t Date Time <br /> SHIP TO LAB Method of Shipment Method of Transport Circle or Add Q <br /> (SUBCONTRACT) V CIRCLE <br /> Walk In ❑ Analysis(es) <br /> W y` APPROPRIATE , QA/ QC <br /> Shipment ID Couner ❑ a as o — _.% 4�.3 MATRIX �7_ ROUTINE ❑ <br /> UPS °�❑ o, oC pu <br /> FED EXP uIF � MATRIX � RWQCB ❑ <br /> LT y OTHER ❑ <br /> g . O � Container s w <br /> LAB USE ONLY Sample Description �o :� ^ � ��r hoe y �' 0- Q { w C* ' — <br /> M Lab No Sample I D Date Time �� y ^ ����� TAT # Type Q REMARKS <br /> x _ x 5 3Y �N _ <br /> f 2 002 - taw - 3 X ! L :G <br /> 3 (Y) j t�.]- l x x x 53 V r& <br /> 4 0(1 x 5ir f; <br /> l L <br /> 6 ?0 ) VA U-) --3 x S .' <br /> 6 00� 0 -3 X X S ;� <br /> t V <br /> a <br /> r <br /> 9 r <br /> 10 <br /> 0 La A►cory St ndir i TAT(Analytical Turn-Around Times 1=24 hr 2=48 hr 3=72 hr Air/Gas 4=1 wk 168 hr 5=2 wk 336 hr Preservatives <br /> © tatxxatory 5landard � y } ( � ( } ( } <br /> ❑ Other H=HCI N=HNO3 S=HzSO. <br /> D Return To Container Types B=Brass V=VOA L_Lder P=Pint J=Jar T=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AC)z O=NaOH T-Na2SzQ <br /> FOR LABORATORY USE ONLY Sample Condition Upon Receipt Special Instrucuons/Cornments <br /> CHILLED Y❑ N ❑ CONTAINER INTACT Y❑ N ❑ <br /> SEALED Y❑ N © #OF SPLS MATCH COC Y© N ❑ <br /> SEAL INTACT Y❑ N 0 *HAZARDOUS FEE Y❑ N ❑ <br /> PRESERVED Y n N t-1 <br /> NOTE <br /> K in nit Frr PI-P EIA?ARDOI IS SAMPI F Di ,POgAl f11STRIRI ETI0N Whiio wilh roport Yollow to ATI Pial,ti) implri r rni4ail (,=ilii i> ­,i nitir <br />