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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 erasures must be done <br />using a single line. r <br />0/1( <br />Initial Storage: Refrigerator 1� By Signature Date & Time: <br />(Printed Nairm) <br />1. Relinquished by;411 V" L� f r �, Date & Time: <br />(Printed Name and Signature] <br />Received by: <br />,ems L, pate&Time- t9 '�a" [ CJ It 7j <br />(Printed Name and nature) <br />Purpose of Custody Transfer: Analysis <br />Remarks: y �.-. &t� G f <br />2. Relinquished by: <br />❑ Retum to Client 11 Disposal Digubcantract El Storage: <br />Date & Time: — 16 1 MrV <br />{Printed Name and <br />Received by: K+Utii I ECnne —L0t,,a-," <br />Lt4 <br />_ Date & Time: <br />(0— 119 - 7-1 Q <br />5. Relinquished by: <br />(Printed Same <br />and Signature) I <br />pate & Time: <br />Purpose of Custody Transfer: <br />EAnalysls <br />11 Return to Client ElDisposal <br />❑ Subcontract <br />Storage' <br />Remarks: <br />Date & Time: <br />(PYinted Name and Signature) <br />3. Relinquished by: a ( <br />h : L a� *l 40 <br />Data & Time: <br />- Z` 1330 <br />❑ Subcontract ❑ Storage: <br />(Printed Nard and Signature) I <br />t"_ �' <br />Date & Time: <br />f r <br />Received by- <br />Date & Time: <br />{Printed Name and Signature} <br />(Printed <br />Name so signal } <br />Received by: <br />Purpose of Custody _i ran afar: <br />Ar+alysis <br />Retum to Clierr.� U Disposal <br />Subcontract <br />M Storage: <br />Purpose of Custody Transfer: <br />, F 4", <br />El Disposal <br />rid <br />112! 101347-02 ' ` 06/08/21 <br />Remarks: <br />SP -05B <br />Remarks: <br />4. Relinquished by: <br />Received by. <br />Purpose of Custody Transfer: <br />Remarks: <br />(Pnhled Name and Signature) <br />(Printed Name and Signature) <br />❑ Analysis Return to Client <br />❑ Disposal <br />Date & Time: <br />Date & Time: <br />❑ Subcontract ❑ storage: <br />5. Relinquished by: <br />pate & Time: <br />(Printed Name and Signature) <br />Received by: <br />Date & Time: <br />(PYinted Name and Signature) <br />Purpose of Custody Transfer: <br />❑ Analysis ❑ Retum to Client <br />1-1 Disposal <br />❑ Subcontract ❑ Storage: <br />Remarks: <br />6. Relinquished by: <br />Date & Time: <br />{Printed Name and Signature} <br />Received by: <br />(Printed Name and Signature) <br />Purpose of Custody Transfer: <br />F-1Analysis ElReturnto Client <br />El Disposal <br />rid <br />112! 101347-02 ' ` 06/08/21 <br />SP -05B <br />Remarks: <br />Advanced 'Technology <br />Laboratories <br />Water -Amber Unpres - 500mL <br />3275 Walnut Avenue, <br />k5 <br />Signal Hill CA 90755 <br />Tel: 562.989.4045 <br />Sampled: 06/03/21 11:22 <br />Page 21 <br />