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.� .� �, r r rr , of <br /> CHAIN OF c �'®DY R o i <br /> ®� FOR LABORATORY USE ONLY <br /> � � t Advanced Technology Method of Transport (Sample Condition Upon Receipt <br /> Client L2 CHILLED fP L'Y� El 4 SEALED Y ❑ N <br /> ® Laboratones P o# ATL ❑ / _� <br /> 3275 Walnut Avenue CA OverN 132 HEADSPACE(VOA) Yl N�5 #OF SPLS MATCH COC Y ®<❑ <br /> Signal Hill,CA 90807 Logged ByDate FEDEX ❑ <br /> (562)989-4045 • Fax (562)989-4040 Other Gid 3 CONTAINER INTACT YJr-N- E3 6 PRESERVED Y ❑ Nt <br /> Client ® ®� Address TEL ( ) <br /> Attn City State Zip Code FAX <br /> Project Name roject# r� ���-� ampler IPrinled mem �(s�rra <br /> Relinquishedby nnSedN a Dale Time Received by(sgnaturoandPnrRedNamat Date Ttme �j <br /> Relinquished'5y g Pnnt met Date If f Time Received by (Signature and PnntedNam) G , Date Time <br /> Relinquished by (Signature and Printed Name) Date Time Received by (Signature and Pnrded Name) Date Time <br /> I hereby authorize ATL to perform the work Send Report To Bill To Special Instructions/Comments <br /> indicated below <br /> Project Mgr/Submitter Atte AM CO CO See <br /> (/�1 � <br /> �/ � <br /> Print Name Date 1 f/ <br /> Address Address <br /> Signature City State Zip City State Ztp <br /> Sample/Records-Archival&Disposal Circle or Add SPECIFY APPROPRIATE OA/QC <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATFIN Z RTNE <br /> receipt and records will be disposed t year after submittal of final report Requested 0 C7 <br /> Storage Fees(applies when storage is requested) <br /> •Sample $2 001 sample/mo(after 45 days) 2 > SWRCB ❑ <br /> •Records $1 00/ATL workorder/mo(after 1 year) ams 0, m AZ ��4- w Logcode <br /> I LAB USE ONLY Sample Description my m� o z� Q e°~ ¢°� o Containers) Co <br /> T Batch# p p g 2° o [m �� �Q J= �, OTHER <br /> ' m O y rx <br /> E �. ro o cs o li b <br /> M Lab No Sample I D /Location Date Time �� �� �ry� �� 60 �o �o �,� ce s,� TAT # Type a REMARKS <br /> --U l7 V <br /> Air <br /> Overnight Emergency Critical Urgent Routine Preservatives <br /> • TAT starts m tollowing day if TAT A= <24 hr B Next Workda C= 2 Workda s DT 3 Workda s E=7 Workdays samples received after S p m H=HcI N=HNO3 S=HzSOe C=4 C <br /> Container T pes 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 /> DISTRIRI(TION Whitp with rannrt YPIInw to fnlr1Pr pink to stihmittpr <br />