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CHAIN Of' CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> IT/ EMCON - 1133 North Market Boulevat d,Sacramento,CA 95831 1'in(,hase Order 129078 <br /> (916)928-33011 FAX (916)928-3341 Lab SEQUOIA <br /> Project Name I ,)n Rogers Analysts Requested <br /> Project Numbei 880039 IA/01050000 <br /> Project Manage, Mark Capps o <br /> Company IT/ -MCON14 <br /> o <br /> Address 3939 'anibridge Road,Suite 220 E <br /> Cai teron Park, CA 95682 0 <br /> Phone (530 676-6881 U X <br /> FAX (5311,676-6885 J ° `Q` <br /> l <br /> Sampler's Stgnal,tre Q) <br /> Sample 7- F' REMARKS <br /> P LAB Samp e l Container Types <br /> D Date Time I D Matrix IIn Preservations <br /> MW-IR 1 dt, l�fu 7 water 3 3 0 <br /> RELINQ[IISt1EDV RECEIVED BY RELINQUISIIED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> 1t' REQU1REhILN FS X I Routine Report <br /> Si nalurl <br /> g � !K ���`�� Signature Signature Signature xa by 49111 s day If Report{includes DUP MS <br /> Standard(—io 15.,k Jaya) MSD,as required,may be <br /> Printed Name Printed Name PflntLd Name Printed Name Provide Verbal Preluninary Results charged as samples) <br /> Provide FAX Preiva nary Fesults III Data Validation Report <br /> Fir Firm Finn Firm Re ueued rte n aa,e <br /> 1:4� .' �� q Po (includes All Raw Data) <br /> R WQCB <br /> Datt/Tinle Date/Time 6atelt uneD, <br /> lte/!line71 <br /> REC VED Ry S {h1Dts/PQLsFf RACED) <br /> REL 1NQlIlS !I D B1' Special Iustruttious/comments Segnma AnalytrLat Contamer Types key <br /> � x <br /> 819 Siril.Lr Ave,Stir 8 40 nil VOA I <br /> SignatitrL Sign ilirL <br /> SaLi,1IL1LntU Ca 95834 125 nil LPL 2HIP V � <br /> � 9k, 921-9600 500mlIPE 3 <br /> PnntLd Nan1L lbrinto Name 1,1{11,11-1 Rub IlubLl I IitLr I WPE 4 <br /> t 300 nil glass 5 <br /> I'irnt --- l inn <br /> I hru glass 6 <br /> I)arLCl1111, D'ItL 1111E 1f nng 7 <br /> s tttttt» t�■II■ tI• � a•! � � � �■ � t11� � � �r [I� t� [I■�t O <br />