Laserfiche WebLink
` <br /> CHAIN OF CUSTODY RECORD Pg z of -.Z <br /> 1, FOR LABORATORY USE ONLY <br /> Sem a Cond�ton U Recei 1 <br /> Method of Transport a� a <br /> Advanced Technology C11erit ❑ 1 CHILLED Y❑ N❑ 4 SEALED Y❑ N ❑ <br /> Labortalones Poll ATL ❑ <br /> 3275 Walnut Avenue CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N O 5 X OF SPLS MATCH COC Y❑ N ❑ <br /> 1 Logged BT Date FEDFX i ❑ <br /> Signal I IsII,CA 90755 3 CONTAIAIER INTACT Y❑ N❑ 6 PRESERVED Y© <br /> (562)989-4045 • Pax(562)989-4040 Other _ <br /> Client 6 t-�C-,P av Address: V55-6 7�e H 'TEL(974 3 7 - �9101S <br /> Alln nJ D Clty eep hi 0 o State G'Y1 ap Coda SI s�4 FAx( l ) 5— - <br /> ProjectNamePMV)�07rotect N Sampler <br /> W° <br /> (Pr ad N e] <br /> Rellnqulahedbfwwm,.amn-d 11-1 I .' f Defy / �ocsrme &� Ftepeluedbytge�+uun,+�.rNmedNan+} {p Dales 2oa5 Tlma (off <br /> Retinquishedby Dale me Date, Imre <br /> Re"umhed by tam-d Pdmad rmmq Date j Time Rewtved W(00 wk".M F kd Nn.) Date Tune <br /> IQ I herMy authmue ATL to perform the wxk Send Report To � Bili To Special rnslrucbvrislCommenfs <br /> Indicated bekrt A� f ; <br /> Projecttlbmltte,r Aft s << << S L <br /> .Ij Z�v> co Sri � tk�-7'PRi <br /> K Name tl Address ° I I Address <br /> Z 3 <br /> city sue—ZIP City Statie �a <br /> SamplelRecords-Ars�iavet�Disposal I' Clroleortd ° SPECIFYAPPPoOPRIATE 0A10C <br /> Urdess otherwise requested 6y citent,all samples wall be disposed 45 days after ! A+�elyals{es) MATRIX O RTNE <br /> reoeipl and records will be disposed t year after submittal of final report Requested CT ❑ <br /> l- <br /> Storage Fees(applies when storage as requested) <br /> 4 <br /> •Sample $2 001 sample/mo(atter 45 days) ��¢ SMC13 ❑ <br /> •Records $100/ATL%vorlaprdea/mo(after i year) Ui LA9 <br /> I LAB USC ONLY Sample Descnptiort §Q�� �o @zP Ion��°off' i �q �_° OTHER <br /> E Lab No Sample I D !Location Dale Irne�, m ,g $� �� �� oQo�'�y lar <br /> AA # Type '4 R RKS <br /> n <br /> n <br /> 1 t i <br /> 03a I <br /> 14 <br /> 3 ja�7' E <br /> n _ , <br /> 4t laZ� � <br /> r <br /> i <br /> t � r <br /> i t } <br /> 9 i <br /> 9 t <br /> V ' <br /> � I � <br /> � 1 <br /> OvernlgYlt Emergency,, C p; Urgent E_ Routine Preservatives <br /> fl -TAT strulsre8 ` olloming day at TAT A- 24 hr B Next wo cy' C� 3 Workda s -7 Workdays H=Hd N=HNO3 O+ "'C <br /> samples er3 pm I! = <br /> ContainerTypes, T= V= P=P J� -Ted ' 1 =G - P=P FA C)� - a <br />