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CHAIN OF CUSTODY RECORD Pg—/ <br /> FOR LABORATORY USE ONLY: <br /> Method of Transport Sample Condition Upon Receipt <br /> 1 Advanced Technology client ❑ ' <br /> 1.CHILLED �� �YgG N❑ 4.SEALED Y❑ N ❑ <br /> Laboratories P•O•#: ATL ❑ <br /> 3275 Walnut Avenue CA OverN O 2.HEADSPACE(VOA) Y❑ N❑ 5.#OF SPLS MATCH COC Y ❑ N ❑ <br /> Signal Hill,CA 90755 Logged By: Date: FEDEX <br /> (562)989-4045 • Fax (562)989-4040 1 1 Other: Vl 3.CONTAINER INTACT Y❑ N❑ 6.PRESERVED Y ❑ N ❑ <br /> Client: GEOCON CONSULTANTS, INC. Address: 3160 Gold Valley Drive, Suite 800 TEL ( 91 6 ) 852-9118 <br /> Attn: ��/ ���fL�l�//> ciry Rancho Cordova State CA Zip code F ) 852-9132 <br /> Project Name: Project 0- Sampler: (Printed Name) (sign <br /> � <br /> G/� f/ Use .-7£940-O�O J�Lo.✓�yi <br /> Relinquished by:(signature and Printed Name) Date: Time:l�G�j Received by:(signature and Primed Name) Date: �� . Time:1-5Z C� <br /> Relinquished by:(sigmtura and Printed Name) Date: Time: Received by:(signature and Printed Name) V r Date: l( 1 I Time: <br /> Relinquished by:(slgnatweand Printed Name) Date: Time: Received by:(signature and Printed Name) Date: Time: <br /> I hereby authorize ATL to perform the work Send Report To: n,C Bill To: Special Instructions/Comments- <br /> indicated below: Attn: —f �y�/���� Attn: <br /> Project Mgr/Submitter: <br /> Co: Cc: �1 <br /> P' ame ate <br /> Address Address <br /> nat Ci State Zi City State Zip <br /> m { R or -Ar hival&Disposal Circle or Add ,V <br /> SPECIFY APPROPRIATE QA/QC <br /> UAI ss othe se requested by client,all samples will be disposed 45 days after Analysis(es) N MATRIX Z RTNE [:1receipt and records will be disposed 1 year after submittal of final report. Requested nt, O <br /> CT <br /> Storage Fees(applies when storage is requested): Q ���Y Q ❑ <br /> •Sample :$2.00/sample/mo(after 45 days) JO `l O� ��R* > SWRCB El <br /> •Records:$1.00/ATL workorder/mo(after 1 year) �y m E code <br /> I LAB USE ONLY: ( ) cwn o9 <br /> Sample Description my m� o Qo Qo o s,� Container(s) <br /> T Batch#: p p ¢ g° �' o 40 Z5 �� w OTHER <br /> Lab No. Sample I.D./Location D to Time o� ti0 ryG o o^� 00 v o <br /> M � �ry��� � �`' �`' �O` �Q' oQ' 3� TAT #/ Type o_ REMARKS <br /> SO !�! / !� G <br /> - ` <br /> 131- 10 � %LI <br /> t <br /> - y / Z 0 9o') <br /> ( T�r <br /> t <br /> CD <br /> CD <br /> t <br /> ,v <br /> t <br /> t <br /> w t <br /> t <br /> Overnight Emergency Critical Urgent Routine Preservatives: <br /> W •TAT starts 8 a.m.following day if TAT:A= 24 h 9 B Next Workda C= 2 Workda s D= 3 Workda s E=7 Workdays H—Hcl N=HNOa S=H:SO. C=4'C <br /> samples received after 3 p.m. 15 <br /> Container Types: T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlar : G=Glass P=Plastic M=Metal Z=Zn(AC): O=NaOH T=Na2S203 <br />