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0 CHAIN OF CUSTODY / LAIIORAT*Y ANALYSIS REQUEST FORM 0 <br /> 1433 North Market Boulevard,Sacramento, CA 9583.4 Scrvtce Rcyuc.sl No,5 PU Number NIA PagL I of I <br /> EM(On (916)928-3300 FAX (_916)928-3341 _ 1 ab CAS <br /> Protect Name Tucheri-Stockton ^� An,dysis Rt- nested <br /> Project Number Ofe:90-002 004,Task 001 <br /> Project Manager Alda Turner J <br /> Company EMCON <br /> Address 1433 North Market Boulevard <br /> Sacramento,CA 95834 ° <br /> U X <br /> Phone (916)928-3300 <br /> FAX (916)928-3341 �~ <br /> Sampler's Signature E x <br /> z N REMARKS <br /> Sample LAB Sample I Container Types <br /> ID Date Time ID Matrix HCI Preurvatiuns <br /> MW-9 1`I5-6 / w.iter 2 2 <br /> MW-10 jhi 15-V6 14 water 2 2 <br /> MW-I I _k, <br /> U k� writer 2 2 <br /> MW-14 41 1687 4 water 2 2 <br /> RE] INQUISHl;U BY LI:IVi:U BY t lN(1ULStIF U BY KIsCl:1Vl:U BY 1 URNARUUNU RhPOR l K1:11U11tEA1LN i'b <br /> tt!<QUIREMENTS X 1 Routine Report <br /> Signature ignature Signature Signature 24hr 4atv 5day Ii Report UncludcsDUP MS <br /> G/. �� 1 /!P /t7 X Si.u.daJ(-to-t5-mUnx days) MSD,.is reyuirt d may he <br /> Prinied Naine Printed Name Primed Name PnntLd Name I4urtdr Vcd.1 Prchmtnsy R,sutls charged as Sauiplcs) <br /> (797, <br /> 97,,��,, Pwu i&PAX Pidinuiwry Reauhs in Data Validation Report <br /> F VL„ ((��[��}} l imi 1 mil f irni Rogmoid Repan Date (includes All Raw Data) <br /> � 1509- RWQCB <br /> DatefPuuc L� �r(l Da Datc/fun� Dd1Ln oneKey <br /> (MDLS/PQLs/rRACE#} <br /> Rt J Ir41U1SH11)dV I REalV UIiY Special In%tructiom/Commenis Container Types <br /> 40 int VOA <br /> I � <br /> 125 int LPE 2 <br /> Signature Stgnalu <br /> re <br /> 500 nil LPE 3 <br /> Printed Name Punted Name I Inn IIDPE 4 <br /> 500 ml glass 5 <br /> Finn Firm I liter glass 6 <br /> 2x6 slh ring 7 <br />