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- A CHAIN OF C ODY RECORD of ®N FOR LABORATORY USE ONLY 1h Laboratories Advanced Technology Method of Transport Sample Condition Upon Receipt - Client ❑ t CHILLED Y /N❑ 4 SEALED Y ❑ NIJ P O t► ATL D 3275 Walnut Avenue CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N❑ 5 A OF SPLS MATCH COC Y 0--N--D Signal Hill,CA 90755 Logged By Date FEDEX ❑ / (562)989-4045 • Fax (562)989-4040 Other 3 CONTAINER INTACT YI N❑ 6 PRESERVED Y 0-1�❑ Client 67 (,--v Address �� : ' 01-a c-11 ►� TEL (9� ) '�/ Tts'Ct Attn �.�� 3 j � city E t c"' 1h, �`� state C't^i Zip code �+ t� FAX Project Name ' Project# Sampler (Printed name) (Signature) , - L1 41, 1t,,�9 ! ! ♦t .off I Relinquished by(si"..and Peened Name) / Date i �" Time Received by (signature and Pnnled Name) Date Z.v C Time Relinquished by (Sign mandPnntedNwra) '` Date Time Received by (sgnature and PantedName) Date Time ()�© Relinquished by (Si9rat-•and NraedName) Date Time Received by(slgnatureand PmdedName) Date Time I hereby authorize ATL to perform the work Send Report To Bill To Special instructions/Commenis indicated below Attn Attn Project Mgr/Submitter E GO 6 Print Name Date Address Address Signature ( City State Zip City State Zip Sample/Records-Archival&Dispgsal Circle or Add SPECIFY APPROPRIATE QA/QC Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX Z RTNE receipt and records will be disposed l year after submittal of final report Requested O CT ❑ Storage Fees(applies when storage is requested) v 1-- •Sample $2 001 sample 1 mo(after 45 days) e < S1#YRCB ❑ •Records $100/ATL workorder 1 mo(after i year) m, •y @~ �,Q it Lo code_ LAB USE ONLY Sam le Descrl tion m� o zP o e° e° p �� Container(s) N T Batch# p p w OTHER sir J �• ELab No Sample I D 1 Location Date Time 00� �ry�p0�ry^�� ^m��0 yon��Q°�,� TAT # Type a REMARKS 6(2 Div I I I I I 1 I •TAT starts t3 a m following day it TAT A= Overnight B Emergency C= Critical D Urgent E_ Routine Preservatives 9 [124 hr Next Workda 2 Workda s 3 Workda s 7 Workda s H=HcI N=HNO3 S=HZO+ C=4 C samples received after S p m Container T pes T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar I G=Glass P=Plastic M=Meta! Z=Zn(AC)2 O=NaOH T=Na2S203