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CHAIN OF CUSTODY 1 LABORATO ANALYSIS REQUEST FORM 9Z IT/EMCON - 1433 North Market Boulevard,Sderatneuto,CA 15834 Smi" Request No Purchase Order <br /> (916)928-3300 FAX(916)928-3341 Lab SEQUOIA <br /> Project Name Don Rogers Analysts Requested <br /> Project Number 11#792773/22613-100 003 <br /> Project Manager Mark Capps <br /> Company IT/ EMCON o <br /> Address 3939 Cambridge Road,Suite 220 <br /> 0 <br /> Cameron Park,CA 9,k682 I <br /> Phone (530)676-6881 <br /> FAX (530)676-6885 ° 00 <br /> c <br /> Sampler's Signature w <br /> REMARKS <br /> sample LAB Sample 1 <br /> Contamer Types <br /> I Q Qate,, Tim i D Matrix HCI I JPrescrvations <br /> MW-IR �' ��/( water 3 3 <br /> TLL <br /> BY M�Njpene <br /> RELIN UISIIED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMLNIS X I RoutineReport <br /> Signature Signature 24hr ae br s day 11 Report(includes UUP,MS <br /> Q-) s..dud{—ials worlrrtgdays) MSD,as required,may be <br /> Printed Nan f Printed Name Printed Name Provide Verbal Preliminary ResulU charged as samples) <br /> Provide FAX Preliminary Results III Data Validation Report <br /> Fttm Firm <br /> Fll Firm Firm Requt�sted Report Ddte (includes All Raw Data) <br /> r�O0 510 nl! �4, 6� !(J RWQCR <br /> Datelrime DatelTime Date/Time DatelTlme (MDL s/PQLs TRACE#) <br /> REI.INQUISHED BY RLCEIVED BY Special I nstructions/Com meats Sequoia Analytical Container Types Key <br /> 819 Striker Ave,Ste 8 40 ml VOA I <br /> Signature, Signature Sacratmnlu,Ca 95834 125 nil I PE 2 <br /> 916-921-9600 500 nil LPL: 3 <br /> Prltitt.d NJmb 11rumd Name Cuntdi t Rob llobt.l 1 liter IIDPE 4 <br /> 500 all glass 5 <br /> Firm I inn 1 liter glass 6 <br /> 20 s!s ring 7 <br /> t i tl M111, t)iwrl+tni 0 ic'i it 8 <br />