Laserfiche WebLink
CHAIN OF CUSTODY/LABORA RY ANALYSIS REQUEST FORM • <br /> 1433 North Market Boulevard Sacramento,CA 95834 y <br /> EMC011 (916)928-3300 FAX(916) 928-3341 Service Request No Purchase Order <br /> Project Name Dan Rogers Lab SEQUOIA CC// <br /> Project Number 22613-100 001 Arta! sts Re nested <br /> Project Manager Deanna Santos o <br /> Company EMCON i o <br /> Address 1433 North Market Boulevard Ei <br /> Sacramento,CA 95834 o <br /> (5 <br /> o CO <br /> Phone (916)928-3300 4. 0 3 r1Qv <br /> FAX (916)928-3341 0 ; W °O <br /> Sampler's Signature kr — w o <br /> Samplez � 0 <br /> I D CAB Sample "� I 1 REMARKS <br /> Date Time I D Matrix g HCl HCI Container Types <br /> MW-111 )70 x OZ.G wale[ 5 3 2 Preservations <br /> REL QTSHED BY RECEIVED BY <br /> L� REI,TNQUISHED BY RECEIVED BY <br /> TURNAROUND REPORT REQUIREMENTS <br /> tgnature Signature REQUIREMENTS <br /> Signature Signature X I Routine Report <br /> t '^�� 24 he 411 hr 5 dby It Repots(includes DUP,M5 <br /> Printed Name Printed Name7( simid till(—I0-15 wurktq day:l <br /> Panted Name Printed Name MSD,as required,may be <br /> Fir A"'""b v"a''t�'"'t""'i'�� charged as samples) <br /> _ Firm Firm amuck d R Prdlkn Da uy Results III Data Validation Report <br /> �i ZG�h� 2/ 5 Firm Rataested Re�wat Dam <br /> Dateffime (includes All Raw Data) <br /> Date/tune Date/i tine RWQCB <br /> RELINQUISHED BYMR110EJ Date/I ime <br /> Special[nstrucll'ZComments F (MDs s1PQLy7RACEti) <br /> Sequoia Analytical Container Types Key <br /> Signature 8195trikcrAve,Ste 8 40 ms VOA t <br /> Sacramento,Ca 95834Punted Name 125 ml LPE 2 <br /> 916-921-9600 500 ml LPE 3 <br /> Contact Rob Bobel I liter HDPE 4 <br /> Firtn500 ml glass 5 <br /> Date/time I liter glass 6 <br /> 2x6 Us ring 7 <br /> 11 glasstar 8 <br />