Laserfiche WebLink
�, �>t�, CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM Page_of <br /> 1433 North Market Boulevard,Sacramento, CA 95834 Service Request No S9$Q 240A PO Number NIA <br /> Emco l (916) 928.3300 FAX (916) 928-3341 Lab CAS <br /> ;Project Name Telchert - Stockton <br /> 'Project Number 20F90-002 004, Task 402 Analysis Requested <br /> Project Manager Matt Turner <br /> Company EMCON -Pinnacle <br /> Address 3939 Cambridge Road, Suite 202 <br /> Cameron Park, CA 95682 U <br /> Phone (530) 676-6881 i,_, w <br /> FAX (530) 676-6885 L- F" <br /> Sampler's Signature ' <br /> Sam !p REMARKS <br /> p LAB Sample 1 <br /> I D Date Time I D Matrix HCl Container Types <br /> MW-9 v 1 water 2 2 Preservations <br /> MW-10 So .1 water 2 2 <br /> MW-1 I j S j 3 water 2 2 <br /> water <br /> water <br /> RLLINQUIS}iED BY RCCEIVLD BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> Signature <br /> REQUIREMENTS X I Routine Report <br /> Sign rc Signature Signature 24 hr 48 hr 5day 11 Report(mLludes DUP MS <br /> ante <br /> PnntLd Nam, X Standard(-10 15-orkmgdays) MSD as required may <br /> bePanted Name Printed Name <br /> Provide Verbal Prelunin Results g p ) <br /> 1 � azr charged as sam lLs <br /> Provide FAX Prcfinimary Resulls III Det i Validation Report <br /> Firm Firm Firm(2,�5 Finn Requested Report Date (includes All Raw Data) <br /> 25-4tcllt <br /> Dalefrime `j/S <�. RWQC13 <br /> ate/Time t S Sk i ate/Time Datefrime (MDLs/PQLs/TRA(.E11) <br /> RELIAQUISHED 13Y RECLIVED BY Spiclal Instructions/Comments <br /> Container Types Key <br /> Signature Signature 40 ml VOA 1 <br /> Columbia Analytical 250 ml LPE 2 <br /> Printed NamePrinted Name 3334 Victor Court 500 ml LPE 3 <br /> Santa Clara Ca 1 liter HDPE 4 <br /> Firm • 408 748 9700 <br /> }im, ml glass S <br /> I/L_ �,. �O cr glass 6 <br /> DateftimeDate/Time A ( p 2x6 s/s ring 7 <br />