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ra rr rr rr r r ■rII T I OF� ar rr r rr ofo <br /> 2 FOR LABORATORY USE ONLY <br /> Advanced Technology Method of Transport Sample Condition Upon Receipt <br /> Client ❑ 1 CHILLED YXf N❑ 4 SEALED Y❑ N <br /> Lahoratoraes P C# ATL ❑ <br /> 3275 Walnut AvenueCA OverN El 2 HEADSPACE(VOA) Y❑ NK 5 #OF SPLS MATCH COC Y�3 N 11Signal Hill,CA 9080'7 Logged By � Date w � FEDEX L�7� <br /> (562)989-4045 a Fax(562)989-4040 Other �6 3 CONTAINER INTACT Y N6 PRESERVED Y N1[ <br /> Cllent Cq ��✓ Address 23 "'� �-� J7 TEL (9Z5 _map <br /> Attn h?. /}�Xa Ctytib-2 -'CP-e state C41 Zip Code9VXrO FAX <br /> Project Name m f Ppop&ct# � / 5 +a/ ��+ Sampler (Printed Name) (Signature) <br /> ,} <br /> Relinquished by (sw a •�� ed N� ate Time ♦ Received by Isg�sure and Pn fed Namey Date .. Time ' <br /> Relinquished by (s yro,u a and Pnrded Name} Date Time Received by (Sgnaiure and PnMed Name) b ,,i , Date Time I, 1 <br /> Relinquished by (Signature and Pnrried Nam) Date Time Received by (Sgnaiure and PnNed Name) bate T+me <br /> I hereby authorize ATL to perform the work Send Report To u Bill To Special tnstructions/Comments <br /> iPro ect M r submitter Ann - 11�C►�a"I` Ann � o >� Pbo--s 11)z-�► ¢ GDB <br /> -J Lkhj- <br /> Co Co '1A <br /> not Name ate <br /> t Address AddreSS <br /> r , <br /> Signature City State—Zip City State Zip WR rJ (S Y°-Xnp <br /> Sample/Records-Archival&Disposal Circle or Add SPECIFY APPROPRIATE Q A/Q C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(es) MATRIX Z RTNE JK <br /> receipt and records will be disposed 1 year after submittal of final report Requested O CT ❑ <br /> Storage Fees(applies when storage is requested) <br /> •Sample $2 601 sample 1 mo(after 45 days) ¢ > SWRCB ❑ <br /> •Records $1 001 ATL workorder/mo(after i year) cc <br /> W Logcade <br /> I LAB USE ONLY Qfi ontainer(s <br /> ) W <br /> T Sample Description W <br /> OTHER <br /> � eCmo <br /> E Lab No Sample 1 Location Date Time TAT # Type a- REMARKS <br /> E SlI D LtDtYp <br /> SV <br /> 21) lW •-7 X23 <br /> /rid✓-S' —W3 <br /> 'Will� <br /> —1vr� 141V -7- <br /> 41 <br /> =startsowtn da +t TAT A— Overnight B Emergency C_ Critical D= Urgent E_ Routine Preservatives <br /> 9 Y — <24hr Next Workda — 2 Workda S 3 Workda s —7Workda sH=HcI N=HNO3 S=HzSO. C=4 C <br /> er 3 p m <br /> Container Types T=Tube V-VOA L=Etter P=PInt J=Jar B=Tedlar G=Glass P-Plastic M=Metal Z-Zn(AC)z Q-NaOH T=Na2S203 <br /> nigTRIRt ITION While with ranort Yellow to folder Pink to submitter <br />