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f <br /> Pg of <br /> CHAIN OF CUSTODY RECORD <br /> f I FOR LABORATORY USE ONLY <br /> Method of Transport Sample Condition Upon Receipt <br /> JJ ® Advanced Technology I Client ❑ 1 CHILLED 1&&, Y P'N❑ 4 SEALED Y❑ N <br /> Laboratories P O u ATI- 13 <br /> 3275 Walnut Avenue <br /> CA OverN ❑ f 2 HEADSPACE(VOA) YO t� 5 A QF SPLS MATCH COC Y_,O-N ❑ <br /> ' �� �� r�^ <br /> Signal Hill,CA 90807 Logged By f7� Date FEDEX ❑ <br /> ff <br /> (562)989-4045 • Fax(562)989-4040 Other 3 CONTAINER INTACT Y�N Q ti PRESERVED Y Q N <br /> Client ��:pCO�j b { (`Address r TEL ( ) <br /> Attn I 1Ecay to Zip Cada FAX( } 1.41 <br /> Project Name II Sampler (Printed Nam <br /> iQ a� Pro e t# IIS p! /}/'-r�f �tlate ✓!�!OI' Time Received by (Sgoaivre and Pnn:ad Name} , <br /> Relinquished by ( ypq S Time 7 <br /> Relinquished by (SlgwureandPmaedNane) Date s I Time eceivedby (s,grorureand PirvedName) Date }!r i <br /> Relinquished by (s,grwasarid Primed Name) Date �I Time Received by (signemreand Primed Name) <br /> Date Time <br /> I herebyauthorize ATL to perform the work Send Report To Bill To special InstructiorislC°mments <br /> indicated Wow p Attn ce I If Attn 9!Z <br /> �0 _�s/ ✓I '�/�f 1 <br /> Project6iigr ISttb Itte O II L3 Wr" Ar ��iee1'1Gff <br /> p -7iQ� Co Co <br /> Print a e rDate Address f I I� Address !,•��r� O �'���� <br /> elanar6rif city te li Zip,[ I city Slate Zip <br /> Sample Disposal Records Archtve I Disposal Circle or Add SPECIFIED APPROPRIATE A�C <br /> Unless otherwise �- Laboratory Standard(1 year) Analysis{ <br /> es) MATRIX ZO RTNE �. <br /> ff Requested — CT Elrequested,all samples El Other }I II <br /> will be disposed 45 days ❑ Return To Q <br /> Storage •Sample $2 00!sample/month(after 45 days){{ �Q SWRCB ❑ <br /> after receipt ` <br /> •Records $100-/ATL workorder/month'{after 1 year) <br /> m � Logcode <br /> �' Containers) <br /> I LAB USE ONLY Sample Description' II f Q0g�m� C° ire�` tea° oma° ��° ED OTHER <br /> T Batch# fi Ae m �, o ym y� o ¢ <br /> E Lab No Sample I D /Location Date Tlme moo moi�ry� wry^ �o �o o. oe g TAT # Type a REMARKS <br /> '� �( I 15 lqlv;&- <br /> �C�V";07- 7 r- <br /> i� <br /> I <br /> I <br /> 19 I <br /> I <br /> I <br /> I <br /> f <br /> I I <br /> III I <br /> � I <br /> 1 <br /> I I II I <br /> 144 I <br /> If �I <br /> I <br /> { Il Il <br /> TAT starts 8 a m following dad TAT A= Overnight B Emergency Critical Urgent E_Routine Preservatives <br /> g y <_24 hr Next warkda C= 2 Workda s D= 3 Workdays -7 Workda s H=Hcl N=HNO3 S=HMSO. C=4 C <br /> samples received after 3 p m <br /> Container Types T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar I G=Glass P=Plastic M=Metal Z=Zn(AC)= O=NaOH T=Nay 2 3 <br /> 1 <br /> f <br />