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ter■ �.... ...ice .�� tttttttttt� ati tiiiiiiiiiii tttltliiii� itttt� Itttttttttt■ Ititititit� Iititit� air <br /> CHAIN OFC TODY RECORD of <br /> TM— <br /> o FOR LABORATORY USE ONLY <br /> Method of Transport Sample Condition Upon Receipt <br /> ALL Advanced Technology Client ❑ 1 CHILLED 7� l�!YEf"'N 0 4 SEALED Y ❑ N <br /> Laboratories P a# ATL 11 <br /> 3275 Walnut Avenue CA OverN ❑ 2 HEADSPACE(VOA) Y N D 5 #OF SPLS MATCH COC "Y ❑ <br /> Signal Hill,CA 90755 <br /> Logged B. hd Date _ FEDEX ❑�, � <br /> (562)989-4045 • Fax(562)989-4040 Other 63 CONTAINER INTACT YZ N❑ 6 PRESERVED Y ❑ N/11 <br /> Client 7 Address '� s}p 1 TEL <br /> Attn t city vr�1L)--*Nk'z State 544 Zip Code TT'o FAx <br /> Project Name Protect# Sampler Printed Name) (Signature) <br /> M R_4_T gb�3 — off, � [ 0—. 6iLA <br /> Relinquished by is y wise and Prated Ners+e) Date7 Time b LVReoeived by tsigruwra end rimed Name) Q Date t 3 rTime 14?,, <br /> OS <br /> Relinquished by'(Signawre end Pnrted Name) Date Time Received by(&gnawre and Prwed Name) Date caw Time wo <br /> Relinquished by (Si"um and PnNed Name) Date Time Received by (signature and Ported Neme) Date Time <br /> hereby authonze ATL to perform the work Send Report To Bill To Special Instructions/Comments <br /> indicated below Ann Attn S <br /> Project Mg Submitter +� tt <br /> 7i1/6- �� C' 1��r1? o <br /> Print Name Date Address Address <br /> Signa ifeCi State Zi City State Zip <br /> Sample/Records-Archival&Dish Circle or Add SPECIFY APPROPRIATE Q A IQ C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(,-,) MATRIX � RTNE <br /> receipt and records will be disposed 1 year after submittal of final report Requested 0 CT ❑ <br /> Storage Fees(applies when storage is requested) ~ <br /> •Sample $2 001 sample!mo(after 45 days) Q > SWRCB ❑ <br /> •Records $1 00/ATL workorder I mo(after 1 year) �� myro\ w��Q Logcode <br /> y o� <br /> Container(s) <br /> l LAB USE ONLYo <br /> Sample Descriptiona0 m �o m2 0 �Q o �Q J� w OTHER <br /> T Batch# <br /> E Lab No Sample I D 1 Location Date Time ry ���; $`� ��3��Qo�� TAT # Type nom. REMARKS <br /> M <br /> K I x V'A <br /> o1, W '3 X30 <br /> t <br /> i <br /> k <br /> l <br /> Overnight Emergency Critical Urgent Routine Preservatives <br /> •TAT starts 8 a m following day d TAT A= �24 hr B Next workda C- 2 Workda s �= 3 Workda s B=7 Workda s H=Hcl N=HNO3 S=HzSO, C=4 C <br /> samples received after S p m Container T pes T=Tube V=VOA L=Liter P=Pint J--Jar B=Tedlar C=Glass P=Plastic M=Metal Z=Zn(AC)z O=NaOH T=Na2S:03 <br />