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CHAIN OFC ODY RECORD or <br /> FOR LABORATORY USE ONLY IW <br /> ® Advanced Technology Method of Transport Sample Codon Upon Receipt <br /> Client ❑ 1 CHILLED SZ) Y❑ N❑ 4 SEALED Y ❑ N <br /> Laboratones p # ATL D <br /> 3275 Walnut Avenue CA OverN 2 HEADSPACE(VOA) Y❑ N❑ 5 R OF SPLS MATCH COC Y LJ'NOI <br /> Signal Hill,CA 90755 Logged By Date _ FE=DEX 13 <br /> (562)989-4045 • Fax(562)989-4040 Other 3 CONTAINER INTACT Y !C] 6 PRESERVED Y ❑ N ❑ <br /> Client )L'L i .0 Address ' } �` +:7f�' ��+ TEL <br /> Attnp'7 fi j— 1tf City L t L� ?�r,r, �' State r Zip Code FAX <br /> Protect Name Protect# Sam ler {Printed Name] (Signature} <br /> Relinquished by (signature and Prided Name) Date , Time Received by (signature and Prided Narrie) <br /> /•tti/�t � 7LL r"�; 6 L Dater a Time SrC <br /> Relinquished by (sigrvtrr end Praised Nam,) /'56 Date Time Received by (sign,iure and Printed Name) Date lime <br /> Relinquished by(signature and Prided Narne) (! Date Time Received by(sgnatura and Pared Nacre) Date Time <br /> I hereby authorize ATL to perform the work Send Report To Bill To Special Instructions/Comments <br /> indicated below <br /> Attn Attn *' 1 2,AO c R 7 d- ED <br /> larotectMgr/Subs mt__r .- r► kr <br /> ' + 1'�. - ,�� I , j t <br /> �9/J r � 4a' Co e)� pec` *' ]� -'` Co `� Afth I'rr rr rrar7 c Ci r / <br /> Pant Name f— ' s Rath <br /> Address Address <br /> / il— <br /> -` Si"nature City State Zip City State Zip F Ri1Z, ` C i;,tLzA_ <br /> SampleIRecords-Archrival&Disposal Circle or Add SPECIFY APPROPRIATE Q Ate/G C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis{es) <br /> receipt and records will be disposed 9 year after submittal of final report Requested MATRIX 0 RTNE <br /> Storage Fees(applies when storage is requested) f_- CT El <br /> •Sample $2 00/sample/mo(after 45 days) <br /> •Records $1 001 ATL workorder 1 mo(after 1 year) 5 mg 0~ ���� =gcode <br /> E LAB USE ONLY Sample h`� a o� o` �' w <br /> Container(s)� Batch# p Description am Qpm `o �= o �� Q o �. O � <br /> a T to w OTHER <br /> — <br /> M Lab No Sample I D 1 Location Date Time 0pP�0� �ry ���o����� �o� ��°�,�� TAT # Type REMARKS <br /> I J- <br /> 00 4 U <br /> CJt?� <br /> tb 1 <br />' U f `f <br /> •TAT starts 8 a m following day if kTAT A- Overnight B Emergency �_ Critical p_ Urgent Routine Preservatives <br /> samples received after 3 p m �i�24 hr Next workda — 2 Workdays — 3 Workda s E=7 Workda s H=Hel N=HNO3 S=H2SO. C=4'C <br /> ontainer T pes T=Tube V-VOAL=Liter P=Pint J=Jar B=Tedlar r G=Glass P=Plastic M=Metal Z=Zn(AC): O=NaOH T=NaaSzOa <br />