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rr r*r rr rr rr <br /> CHAIN OF CUSTODY 1 LABORAT !' ANALYSIS REQUEST FORM 94? <br /> IT/EMCON- 1433 North Markel Boulevard,Sai-ranieulo,CA 95834 Service Request No Purchase Order <br /> (916)928-3300 FAX (916)928-3341 Lab SEQUOIA <br /> Project Name Don Rogers Analysts Requested <br /> ProjeLi Number ]T#792773/22613-100003 <br /> Project Manager Mark Capps �D <br /> Company IT/EMCON v <br /> Address 3939 Cambridge Road,Suite 220 <br /> Cameron Park,CA 95682 1c <br /> Phone (530)676-6881 U <br /> FAX (530)676-6885 <br /> Samplers Signature o Cry w <br /> E x <br /> REMARKS <br /> Sample LAB Samp e I Container Types <br /> I D le- Ttm I D Matrix NCI Preservations <br /> MW-IR �J' r 3 water 3 3 <br /> I <br /> REL1NMYEPBY PREC REI IN l]ISIIED BY RECEIVED BY TURNAROUND REPORT REQU1REAtENTS <br /> RLQUIRLAILNIS X I Routine Report <br /> Signature Signature s4 hr 48 hr s day Il Report(mcludo DUP,MS <br /> MSD,as required,may be <br /> Printed Nai _ Printed Name Printed Name Provide Verbal Preliminary Resulu charged as samples) <br /> vl�, Provide FAX Preliminary Resulu III Data Validation Report <br /> Firmr J�J r J Firm 6/ G U Finn Firm "ualed Repon Due (includes All Raw Data) <br /> r U RWQCB <br /> Date/Time Date/Time Date/Time jDateiTime (MDLs/PQLs(fRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Inslruclrons/Comments Sequoia Analytical Container Types Key <br /> 819 Striker Ave,Sic 8 40 nil VOA 1 <br /> Signature. Signature Sacramento,Ca 95834 125 ml LPE 2 <br /> 916-921-9600 500 ml LPE 3 <br /> Printed Name Printed Name Contact Rob Bobel I liter HDPE 4 <br /> 500 ml glass 5 <br /> i um I irin 1 Iver glans 6 <br /> 2x6 sls ring 7 <br /> Daiel'flmc Date/Time glassjar 8 <br />