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i <br /> CHAIWOF CUSTODY RECORD Pg of <br /> i FOR LABORATORY USE ONLY <br /> �I Method of Transport Sample condition upon Receipt <br /> L , Advanced Technology Client ❑ 1 CHILLED 4 N❑ 4 SEALED Y ❑ N <br /> Laboratones P o ATL ❑ <br /> 327'5 Walnut Avenue �JCA OverN ❑ 2 HEADSPACE(VOA) Y❑ Rd 5 #OF SPL$MATCH COC Y ON ❑ <br /> Signal Hill,CA 90807 Logged By I1 11 It1.Date FEDEX ❑ <br /> (562)989-4045 • Fax(562)989-4040 Other S�' 3 CONTAINER INTACT Y�N 6 PRESERVED Y ❑ N <br /> Client Address t <br /> �" rEL <br /> ( ) <br /> Attn �i 'r� City , f State Zip Code Wx <br /> PZ,WProject Name Project# �/" r Sampler (Printed Name] ural <br /> 7nt &4 <br /> a)._ <br /> Relinquished by Ne r,ai Dater+ ,� IlTime Received by (sgmtu're and Pnmad Narne) I Date _ <br /> Relinquished <br /> ' Time P <br /> V <br /> Relinquished by (4Z.a .and F u4ed Date Time m <br /> Received by (signature and Printed Nael 1 Date ZC Tlma ,` <br /> Relinquished by (signature and Pnrded Name) Date Time Received by (Signature and Pr"ed Name) t Date Time <br /> I herebt authorize ATL to perlorm the work Send Report To I Bill To Special Instructions/Comments e + <br /> indicate]below Attn l Attn <br /> Proje(t Mgr/Submitter - <br /> i <br /> �I _ <br /> Print Name Date Address II Ir <br /> /dress <br /> I i - <br /> r Signature I Ci State Zip City State Zip <br /> Samtl R c rd -ATchivF11 fi DisposalCircle or Add SPECIFY APPROPRIATE Q A 1 Q Q <br /> Unless otherwise requested by client,all samples will be disposed 45 days after l Analysis(aS) MATRIX RTNE <br /> receipt and records will be disposed 1 year after submittal of final report E Requested 0 CT El <br /> Storage Fees(applies when storage Is requested) ( I <br /> -Sample $2 00/sample/mo(after 45 days) Q > SWRCB <br /> •Records $100/ATL workorder/mo(after 1 year) t g a �40 <br /> LAB USE ONLY ` g ro o� o� O 3� Container(s) U) <br /> T Sample Description Qin om �o ms �o � oa ¢ _ OTHER <br /> Batch# z <br /> E Ir <br /> M <br /> Lab No Sample I D 1 Location Date Time �� �o� �ry� �ry� �a �° �o �� �¢ �,� /TAT Type a REMARKS <br /> I I <br /> g]l <br /> 7W- <br /> Preservative <br /> E I <br /> l <br /> A I <br /> I <br /> - I <br /> 1 <br /> I , <br /> I I <br /> I - <br /> I I <br /> I <br /> I <br /> I <br /> I , <br /> I I <br /> Overnight =Emergency Crtiical Urgent Routine PreservativesTAT startsS following day d TAT A= L24 hr B C- Was B= 3 Workda s E=7 Workdays] H=Hcl N=HNO3 ASO. C=4 C - <br /> samples re�atter S p m Container,T es T=Tube V=VOA L"L.iter P= J=Jar B=Tedlar I G=Glass P=Plastic M=Metal iZ=Zn(AC)z 0= T=Na:•Sz03 <br /> Toi I le ,nth r Voll Iriar n cif ' <br />