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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: Purchase Order: <br /># EM(01`1 (916)928.3300 FAX(916)928-3341 Lab: CAS <br /> Project Name: Teichert& Sons,Stockton Analysis Requested <br /> 0 Project Number: 20F9D-#n007 <br /> m iProject Manager: Matt Turner e <br /> N <br /> Company: Pinnacle F c Q <br /> o Address: 3939 Cambridge Road,Suite 220 E c o o < <br /> 00 <br /> Cameron Park,CA 95682 S ¢ < <br /> Phone: (530)676-6884 w w w <br /> FAX: (530)676.6885D <br /> 'Sampler's Signature: a C C7 K o <br /> zz F c CI C F° REMARKS <br /> Sample Sample -- Comainer Tyyes <br /> I.D. Date Time I.D. Matrix == Preservalior65 <br /> TK-5E 3.!23/99 16:13 ! soil I X X <br /> z TK-5CE 3.23'99 16:16 soil I X X <br /> 0 <br /> TK-5CW 3,23/99 16:20 soil I X X <br /> u� <br /> TK-SR' 3.x23;99 15:35 soil 1 X X <br /> TK-6E 323i99 16:02 soil I I X X <br /> TK-6CE 3i23i99 16:07 soil 1 X X <br /> o TK-6CW 3!2399 16:10 soil I X X _ <br /> 3/23x99 15:38 soil 1 X X <br /> m <br /> m <br /> REL Q R IVE H5' RELINQUISHED BY RECEIVED l yr, 7'L'R\AROC�'D REPORT REQUIRENWNTS <br /> REQUIREMEN"IS X 1. Routine Report <br /> '- <br /> Signature S a4r Signature Sienature unx is lv ;,;,. 11. Report{includes DU?,\7S <br /> Harold Uuke IN 1"�'ceI rr y.� smnerd(-,�••s.ort:,a ia,x) MSD,as requimi-mey be <br /> Printed Name Printed Nme Prinkd Name Printed Name vo,�d. rr.Rs�:min�y rs��:i charged as samples) <br /> ETICONOAS amid, 111.Data Validation Report <br /> Fi Finn Pym 9 m, Ra Dm. (include;,UI Raw Data) <br /> Fi #A . t4 32 n dtlr1 "1-J'0 RIVQCB <br /> Data'fi e Dale/fDale/fude DateRin DaretTime <br /> (MDI_s1PQLs'TRACEM) <br /> RELINQUMMD BY RECM7ED BY Special toctruetions��/Cc�,omJ�;eo �.r Container Tyyes Kr: <br /> pry-( C�a�'t I ' ' r' r 40 ml VOA: I <br /> O Signature Swamte 1) For oay'genats,an lyze for MTBE,IBA,DIPS,ETBE,and TAME 250 ml LPE: 2 <br /> using 8260 510 ml LPE: 3 <br /> r Prinkd Name Printed Name 2) If toW lead by 7420 is greatcr than 50 ppm,then aoalyz for mral lead by 7421 r liter HDPE: 4 <br /> ,r r 500 ml glass. 5 <br /> r Firm Finn �.`e ; lL! I J q O, t I liter rias: 6 <br /> vwi _ •a"" I f! f r 2X6 sk ring: 7 <br /> Dmffima Darcflime --. __ .. <br />