Laserfiche WebLink
i <br /> CHAIN OF CUSTODY / LABOR*RY ANALYSIS REQUEST FORM i <br /> IT/EMC - 1433 North Market Boulevard Sacramento CA 95834 Purchase Order <br /> , 129078 <br /> (916) 928-3300 FAX(916) 928-3341 Lab SEQUOIA <br /> Project Name Don Rogers Analysts Requested <br /> Pioject Number 880039.1A/01050000 <br /> Protect Manager Mark Capps N <br /> Company IT/EMCON o <br /> Address 3939 Cambridge Road,Suite 220 <br /> Cameron Park,CA 95682 <br /> Phone (530)676-6881 ^ <br /> FAX (530)676-6885 ° <br /> h � � <br /> Sampler's Signature �- C7 waa <br /> x <br /> REMARKS <br /> Sample LAB Sample t Container Types <br /> I D Date Time I D Matrix HCI Preservations <br /> MW-IR 1 [0 1q0-7 water 3 3 <br /> RELINQUISEE ll Y RLCEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report , <br /> SignatureSignature Signature Signature 24 hr 48 hr s day it Report(includes DUP,MS << <br /> (�i4s $%wdud(-10.1 S worluny dey,) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Veibcl Prchmmery Roulu charged as samples) <br /> Provide FAX Prehminery Resulu Ill Data Validation Report <br /> Fim Fu m Firm Firm Requesied Repon Due (includes All Raw Data) <br /> / r <br /> 4&1 40 RWQCB <br /> Datcll m,l. D ite(Time Dale/!hitt Date/Time (MDLsIi'QLsJTRACE#) <br /> RE I INQHSI1ED BY —RECEIVED By Special instructions/Comments Sequoia AnalytlLal Container Types Key <br /> t <br /> � 819 Stn6l,r Ave,Ste 8 94 nil VOA 1 <br /> Slgivatark, Segrel 7 Sdwauiwau,Ca 95834 125 nil l PC 2 <br /> tM y!-] 916 921 9600 500 ml LPE 3 <br /> !' WILd Much, Pl inName, Contac Rob litd,n,I I liler 111013 4 <br /> 500 ml glass 5 <br /> I isnl Iulti I liter glass 6 <br /> 20 sib ring 7 <br /> l),If�fl]fll� �— I)lll linin plass lar $ <br />