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ATL internal Chain of Custody Internal COC Version: 06042021 <br />(Legal or Evidentiary purposes) <br />This Chain serves as record of possession of sample from sample receipt, sample preparation, sample analysis and <br />storage at all periods of time. Please make sure that all entries are made using indelible ink and <br />erasures must be done <br />using a single line. <br />By: ��"t vn f�� Signature G_ - <br />Date & Tme: <br />Initial Storage: Refrigerator <br />(Printed Name) <br />1. Relinquished by: `ti $ MorAles - C� (IM /,,,l Date & Time: <br />J <br />� �r Lf � �to <br />(Printed Name <br />nend <br />�Siignnaturej <br />Received by: VeL. � IIS _L�"'' Date & Time: <br />�Z L) Cl 3iL� <br />( rued N e and 5 nature) <br />Purpose of Custody Transfer: ❑ Analysis ❑ Return to Client ❑ Disposal Subcontract <br />El Storage: <br />Remarks: C U t_ n,=!} fe ^ 6" <br />2. Relinquished by:. ys�-t �-'f Gate & Time: <br />r <br />r✓ Z t UVIO <br />(Prints Name and Signature) <br />�� <br />Received by: u M F `f Y -y 1? i ll L 4in a in Date & Time: <br />(Printed ame and Signature) <br />Purpose of Custody Transfer: EFAnalysis El Return to Client El Disposal Suboontract <br />Storage: <br />Remarks: �'!�`�w 1 <br />3. Relinquished by: M41i f` -6h" efl — L G! h7 GCS? P'Lc• Date & Time: <br />(Printed Na and Signature) <br />Received by: «"_ Date & Tme: <br />r`g 1 33r. <br />rPrinte Nerna and Sig ure) <br />Purpose of Custody Transfer: I__I Analysis I__! Return to Client 0 Disposal 17 Subcontract Bttorage: <br />Remarks: ro &-, tcA f -4-o — Hi- <br />4. Relinquished by: <br />Received by: <br />(Printed Name and Signature) <br />(Printed Name end Signature) <br />Date & Time: <br />Date & Time: <br />Purpose of Custody Transfer: ❑ Analysis Retum to Client ❑ Disposal Subcontract Storage: <br />Remarks: <br />5. Relinquished by: <br />Received by: <br />(Printed Name and Signature) <br />(Printed Name and Signature) <br />Date & Time: <br />Date & Time; <br />Purpose of Custody Transfer: ❑ Analysis El Return to Client ❑ Disposal ❑ Subcontract 0 Storage: <br />Remarks: <br />6. Relinquished by: <br />Received by: <br />(Printed Name and Signature) <br />(Printed Name and Signature) <br />Date & Time: <br />Purpose of Custody Transfer. 1-1 Analysis ❑ Retum to Client El Disposal C 2101347-01 A <br />Remarks: SP -04B <br />ON Advanced Technology Laboratories <br />jd'jh, 3275 Walnut Avenue, Signal Hill CA 90755 <br />SOW Tel: 562.388.4045 <br />0610$121 <br />a <br />lVater-Amber Unpres - 500mL <br />S a nipl e d: 06/03/21 11-104 <br />Page 19 of 33 <br />