Laserfiche WebLink
CHAIN OF CUSTODY/ LABORAOY ANALYSIS REQUEST FORM 0 <br /> I433 North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order /d <br /> E[7<1COf1 (916)928-3300 FAX (916)928-3341 Lab SEQUOIA <br /> Project Name Don Rogers Anal sis Requested <br /> Project Number 22613.100 001 <br /> Project Manager Deanna Santos y o <br /> Company EMCON r00 <br /> Address 1433 North Market Boulevard c 5 <br /> 00 <br /> Sacramento,CA 95834 0 a ¢ <br /> Phone (916)928-3300 N m <br /> I <br /> FAX (916)928-3341 00 <br /> Sampler's Signature t"� 0 0 <br /> z o REMARKS <br /> Sample LAB Sample - t I Container T s <br /> I D Date Tlme I D Matrix HCI HCI Preservations <br /> MW-1R 1'ly � QZ�G water 5 3 2 <br /> i <br /> REL QUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> c--- REQUIREMENTS X I Routine Report <br /> agn�ure Signature Signature Signature 24 hr 48 au 5 d.y Il Report(includes DUP,MS <br /> „ ,Ae ,/1-11 X Suadama(—ua•ts wkukiay days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Primed Name Pnwkk verLal Prutmdnery ResWu charged as samples) <br /> PrA&FAX Wimmary P"Wis III Data Validation Report <br /> 4 Fin (includes All Raw Data) <br /> _ Firm Firm Finn R pest d Repan Date <br /> �1u4`a,1~ 2 1 5 RWQCB <br /> Dateffime Date/rune Date/Time Datelrime HMDLs1PQLsffRACE#) <br /> RELINQUISHED BY RECEIVED Special Instructions/Comments Sequoia Analytical Container Types Key <br /> f 819 Stnker Ave,Ste 8 40 ml VOA I <br /> h Signature 911, Sacramento.Ca 95834 125 ml LPE 2 <br /> Sn n 916-921-9600 500 ml LPE 3 <br /> Printed Name PriptamarrieContact Rob Bobel I later HDPE 4 <br /> 500 ml glass 5 <br /> Firm LI later glass 6 <br /> 2x6 s1s nng 7 <br /> Date rime pDaLk= I glassiar 8 <br />