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I ' _ <br /> CHAIN OF CUSTODY RECORD <br /> Pg I of Z- <br /> ® t FOR LABORATORY USE ONLY j <br /> if Method of Transport Sample Condition Upon Receipt <br /> ® Advanced Technology I <br /> Laboratories P O# I Client ❑ 1 CHILLED Y N❑ 4 SEALED Y ❑ N ❑ <br /> ATL ❑ <br /> 3275 Walnut Avenue i; CA OverN ❑ 2 HEADSPACE[VOA) Y,❑ N❑ 5 It OF SP1.5 MATCH COC Y ❑ N 0 <br /> Signal Hill,CA 90807 Logged By I u Date FEDEX <br /> (562)989-4045 • Fax(562)989-4040 ( Other _ 3 CONTAINER INTACT Y❑ N❑ 6 PRESERVED Y ❑ N ❑ <br /> Client ��► Address Zj � t TEL c 7.5`13�� — ►o� <br /> Attrtr,-s Q j Cityr fPL State Zip Code �� FAX <br /> Project Name �N� r ect# $ ' Sampler (Printed Name] r {SugnaSure) <br /> Relinquished by (s s i end nted Ne�ay O Date Time Re elVed t]y (Sg uluro end Prmtad Namey Date Ttme <br /> Relinquished by (signature end Pnnted Name) Date I �I Time Received by (signature and Panted Nan»} Date � Time <br /> Relinquished by (5'griatero end Printed Nemo) Date Time Received by (signature and Pn tted Name) Date I I Time <br /> I hereby authorize ATL to perform the work Send Report To 7—t II Bill To Special Instructions/Comments <br /> indr Atte) Attin <br /> roject Mgr/ ubmltter <br /> C 7,pQ Co Co <br /> not N a Oate <br /> Address � I I� Address <br /> City State 1 Zi EI City State Zip <br /> am I -Archival Disposal I Circle or Add SPECIFY APPROPRIATE Q A/Q C <br /> Unless otherwise requested by client,all samples will be disposed 45 days after f Analysis(es) MATRIX z RTNE <br /> receipt and records will be disposed 1 year after submittal of final report IRequested 0 OT ❑ <br /> Storage Fees(applies when storage is requested) F- <br /> * <br /> •Sample $2 00/sample/mo(after 45 days)' ¢ > SWRCB ❑ <br /> Records $100/ATL workorder 1 mo(after 1 year) <br /> I LAB USE ONLYI y P o~ a Contamell vy <br /> T Batch# Sample Description I Qin `em �,a os o �Q a �Q Jho J-1 <br /> OTHER <br /> MLab No Sample I D /Location Date lTIme1 ��"� �ry ��� �o yp�3��, �,�� TAT # Type] REMARKS <br /> -bill hjW •-3 3 V1 d <br /> Pik/ I n <br /> it <br /> r <br /> [ it <br /> u ' <br /> I <br /> I <br /> I ' <br /> • TAT starts 8 m follow+n dad TAT A= Overnight E1 Emergency C= Critical O_ Urgent E_ Routine Preservatives <br /> 9 y <24 hr Next work da rkda s = 3 Work da s =7 Workda s H=Hcl N_HNO3 H=SO. C=4 C <br /> samples r atter 3 p m <br /> i Container Types T=Tube V=VOA L=Liter P= J=Jar B=Tedlar ; G=Glass P=Plastic M=Metal Z=Zn(AC}� 0= T=Na2S203 <br /> wTRIMN (with rMlYelIMMIdermto sum I® = '5 <br />