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� �� .... ■.w� i� iliw� two !■� � � 1!1!� � � � CHAIN OFC ODY RECORD of ® FOR LABORATORY USE ONLY Advanced Technology Method of Transport Sample Condition Upon Receipt Client 0 1 CHILLED (f Y 2/N 4 SEALED Y N 12 Laboratones P°# ATL ❑ 3275 Walnut Avenue f a CA OverN ❑ 2 HEADSPACE(VOA) Y❑ N�1 5 #OF SPLS MATCH COC Y 0T N ❑ Signal Hill,CA 90755 Logged By � Date � FEDEX ��❑ � �,P� (562)989-4045 • Fax(562)989-4040 Other 3 CONTAINER INTACT Y N 0 8 PRESERVED Y N ❑ Client ;,�F,0 60 N Address 5� �r-_�r- oil,q 069-- TEL ( 4v, )3`1I -5406 Attn MATT- ()ANMI1 C"1'!' city LTQ afykoState G2A Zip Code 5507 I FAX( ? 5916 Project Name W C�� ,fin A e/ ,/ r-r Project# f N 4 i Sampler (Printed Name) (Signature) Relinquished by (srgne+ure and Pndod Name) 1Y1��CLsrT Date t G -j 3_C) Time 113C) Received by(signature and Printed Name) 4 Date Time p�/,v Relinquished by (srgnelure arra Pnnred Name) Date Time Received by (srgnasure and Panted Name) Date Time Relinquished by (srgnetum and Pnraed Name) Date Time Received by (signature ana PnMed Name) Date Time I hereby authorize ATL to perform the work Send Report To Bill To Special Instructions/Commenis indicated below AtteMA 1A til 40h F a' M_ Attn 12-GO = 'C-061:51 15 T CYN Pro ect Mgr/Submitter 41 Cc CEr!:%Ucx Co �i3 0 FQ O irl l ri>'+ i= 10�-(3.04 CSF © bu I Print Name Date Address �1Address Signature City State Zip City State Zip SSrQplglEecords-Archival&Disposal Circle or Add SPECIFY APPROPRIATE Q A C Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX Z RTNE � receipt and records will be disposed 1 year after submittal of final report Requested O CT ❑ Storage Fees(applies when storage is requested) ~¢ •Sample $2 001 sample/mo(after 45 days) 2 > SWRCB ❑ •Records $1 001 ATL workorder/mo(after 1 year) o�q m �Q� - w Lngcode_ LAB USE ONLY � Container(s) Sample Description tion mOTHERT Batch# MLab No Sample I D /Location Date Time �o� �ry�° �^ �° �,�� Q �� TAT # Type a REMARKS 00 G- Z lV� i F o L, m vi - A 5 0c M w �p n mW - (v50 Overnight Emergency Critical Urgent Routine Preservatives •TAT starts m fallowing day if TAT A, -<24 hr B Next Workda C= 2 Workdays D= 3 Workda s E=7 Workdays H=Hcl N=HNOa S=H:SO. C=-4 C samples received eived after 3 p m Container Types T=Tube V=VOA Lwl.der P=Pint J=Jar B=Tedlar ' G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOH T=Na:S:03