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� � � MOW dKTOVV FMeO FRP M = a = JM of 1= <br /> or') FOR LABORATORY USE ONLY Now <br /> � <br /> Method of Transport �, eSampfe Condition Upon Receipt <br /> 'PI Advanced Technology Client ❑ <br /> 1 1 CHILLED Y.P/N❑ 4 SEALED Y ❑ N Eff <br /> �» Laboratones 130# ATL ❑ / _/ <br /> 3275 Walnut Avenue Q S CA OverN ❑ 2 HEADSPACE(VOA) Y El Nei 5 #OF SPITS MATCH CCC Y Iii N ❑ <br /> Signal Hili, CA 90807 Logged By Date FEDEX ❑ <br /> (562)989-4045 • Fax(562)989-4040 Other O S a 3 CONTAINER INTACT Y.P/N❑ 6 PRESERVED Y ❑ NO <br /> Client (W Address TEL_( <br /> 1 ) <br /> Attn "6 a City 'J State Zip Code F ( <br /> Project Name Project# Sampler NKe <br /> Relinquished by is ) Date �7� Mme ,' Receved by�mted <br /> ignatsuaa Pnrded Name) Dat Mme f O <br /> e <br /> Relmquishedby ) gnetureandPnnledName) Date Time I Received by{sgnatureadPnntedNamal 1 Date Time 5 — <br /> Relinquished by {Signature and PnNed Name) Date Time Received by (Signature and Pmded Name} Date Time <br /> I hereby authorize ATL to perform the work Send Report To Sill To A S e i IIns tructions/Com <br /> indicated below AM �[A6 Attn f ` !Y�_V � <br /> Project Mgr/Sirw?4 e,*It�'e <br /> b ttter � t / <br /> fC <br /> Print Name ate Address L r vee,!;, Address 0'- <br /> namr Ci Slate—Zip City State Zip JJ <br /> Sample/Records-Archival&Disposal Circle or Add SPECIFY APPROPRIATE Q A C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX z RTNE <br /> receipt and records will be disposed 1 year after submittal of final report Requested O CT <br /> Storage Fees(applies when storage is requested) <br /> •Sample $2 00/sample/mo(after 45 days) Q > SWRCB <br /> •Records $1 00/ATL workorder 1 mo(after 1 year) ami m" m \ Q w Logcade_ <br /> I LAB USE ONLY Sample Description o� Container(s) <br /> OTHER Batch# W <br /> E �ry �° �� °�' hm o� e° TAT # T e Q REMARKS <br /> i M Lab No Sample I D 1 Location Date Time � �° �ti �ry � � � � s' �, � yp <br /> o�s�c �r /�11 L�✓� VC <br /> �1?34 <br /> Asa Grr— <br /> rn;�Q <br /> 77 <br /> •TAT starts t3 a m following da rf TAT A— Overnight 13 Emergency C_ Cntical p_ Urgent E_ Routine Preservatives <br /> samples received after 3 j3 m y ` <24 hr Next Workda = 2 Workda s — 3 Workdays] =7 Workda s H=Hcl N=HNO3 S=H2SO. C=4 C <br /> Container Types T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar � G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOH T=Na2S203 <br />