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e)* CHAIN OF CUSTODY / LABORA*Y ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request PO Number NIA <br /> I <br /> EMCOf1 (916)928-3300 FAX (916)928-3341 Lab CAS <br /> Project NanlL Teichert-Stockton Anal sis Requested <br /> Project Number 20F90-002004,Task 001 <br /> Project Manager Matt Turner v <br /> ('0111pany LNICON <br /> Address 1.133 North Market Boulevard <br /> c <br /> Sacramento,CA 95834 <br /> V <br /> ['11011,. (916) 928-3300 <br /> 0 4y <br /> 1— <br /> AX (916) 928-3341 .. � <br /> Sampler's Signature L_L_—� 2 <br /> X <br /> z REMARKS <br /> Sample LAB Sample I CuntatncrTypes <br /> ID Date I Time ID Matrix HCl Prl\trVa00n5 <br /> MW-9 -511-1 io hE / water 2 2 <br /> MW_10 S I1 4 y 12v1 v� water 2 2 <br /> MW-11 An ,6 1 a water 2 2 <br /> MW-14 )1d1O water 2 2 <br /> KI 1 iNQUISHF D BY RMI,WE D BY RELINQUISHF 1)BY RECEIVE 1)13Y rURNAROUND Rh POR 1 RI QUIRE RIF N rS <br /> P 4� RI,QUIRFMFNTS X -1 Routim Ripon <br /> Signawr� gnature Signature Signature 24 hr 48 hr sa.y fl RLpun(lnl.tuck,DUP MS <br /> 5 lea t c>rr, 1Jr- z <br /> 10 15 wod,nb Lya) MSI) ati rLgUirLd may be <br /> PI'MiLd MIMI. Pnnitd Namur Printed Name Pnn[ud Name I'ro.,1 v,n 1 l rtlmun vy x„�u, ellargLd as NanlptLs) <br /> MC-c.ti , 1',—A I AX I'mI m nary R. UIL, Ill Data Validation Repon <br /> f inn f 1rn1 Firm FIrIn k,yu—L nu�lud.n All Raw Data) <br /> ha1�/1 nik DaIJTcur��, Dalurrnnx DaIJI line I MDL V1101 +/I RA(LH) <br /> KI I INQUIS111 1)fly RkEIVED0 Special Instructions/comments (0111a1ur7ypcsKfy <br /> 41)nil VOA <br /> Sl,ilatUrL SlgnalurL 121 nil 1 PE 2 <br /> SUIT nil 1 PE 3 <br /> Pnnitd Nains1 1'nntLd Name i Mir IIDPE 4 <br /> 51111 nil glass 5 <br /> 1-Inn Finn 1111Lr glass 6 <br /> 2 K6 s!s ring 7 <br /> D iii(Time I DaiL/r1mc plus,lar K <br />