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ATL Internal Chain of Custody <br />(Legal or Evidentiary purposes) <br />Intemal COC Version: D6042021 <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. <br />Initial Storage: Refrigerator rBy: � � � Signature ��� Date & Tme: J` – f [G• <br />(Printed Name) <br />1. Relinquished by: A�f�t y 1� R ('M6P1 Date & Time: ` 17 ` 2j 155 ,' <br />(Printed Name and Signature) C <br />Received by: (j�- L., r �'h Date 8 <br />(Printed pmelnd Sign ') <br />Purpose of Custody Transfer: ❑ Analysis ❑ Return to Client ❑ Disposal 19�ubcontracl El Storage: <br />Remarks: u L 1 `'h 4y. u LrI 1� r^� <br />2. Relinquished by: f'°-''"` Date & Time: L -7 <br />(Printed ame and nature) ` <br />Received by: Fent, e — a q Date & Time: lD – 119 + Z 1111, 1 C) <br />(PrfnO6 Name and Signature) <br />Purpose of Custody Transfer: El Analysis ❑ Return to Client Disposal El Subcontract ❑ Storage: <br />Remarks: 4 " � ��� La.. ,o n tp <br />3. Relinquished by: 'ems [0! t !.Y*, Date & Time: U -1 4_Z [ Gia <br />(Printed Name Vnd Signsfure) <br />Received by: jb"e_ L'�r <br />(Printed Name and Signefure} <br />Date & Time: <,-1,$-Z4 1 7 &, <br />Purpose of Custody Transfer: l.__! Analysis LJ Ftetum to Client U Disposal U Subcontractt Storage: <br />Remarks: L <br />4. Relinquished by: <br />Received by: <br />(Printed Name and Signature) <br />(Printed Name and Signature} <br />Date & ;,ame: <br />Date & T)rane. <br />Purpose of Custody Transfer: ❑ Analysis ❑ Return to Client ❑ Disposal Subcontract E] storage: <br />Remarks: <br />S. Relinquished by: <br />Received by: _ <br />(Printed Name and Signature) <br />(Printed Name and Sign afure} <br />Date & Time: <br />Date & Time: <br />Purpose of Custody Transfer: 0 Analysis D Return to Client ❑ Disposal ❑ Subcontract 1:1 Storage: _ <br />Remarks: <br />6- Relinquished by: <br />Received by: <br />(Printed Name end Signature) <br />(Prinfed Name and Signature) <br />Date & Time: <br />Purpose of Custody Transfer: Analysis Retum to Client Disposal [ Q 34�-V 3 A 06/08/21■ <br />Remarks: SP -10B ■ <br />0, Advanced Technology Laboratories <br />j 3275 Walnut Avenue, Signal Hi11 CA 90755 Water -Amber Unpres - 5OOmL <br />Tel: 562.989.4045 Sampled: 05103121 12:47 <br />Page 24 of 33 <br />