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CHAIN OF CUSTODY / LA.BOORY ANALYSIS REQUEST FORM • <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Ser equest No: Purchase Order: <br /> Fmc h (916)928-3300 FAX (916)928-3341 Lab: CAS, Santa Clara <br /> Project Name:Teichert&Sons,Stockton Analysis Requested <br /> ,Project Number: 20F90-002.007 <br /> Project Manager: Matt Turner <br /> Company: Pinnacle v 0N0 <br /> to rn o Q <br /> !Address: 3939 Cambridge Road, Suite 220 q o o <br /> Cameron Park CA 95682 [ oo co °° <br /> la¢ a a <br /> Phone: (530)676-6884 <br /> FAX: (530)676-6885 � - - -- _ 0 C4 V) <br /> Sampler's Signature: <br /> a. x <br /> z F G4 O REMARKS <br /> Sample B amp e BT BT BT BT Container Types <br /> I.D. Date Time 1.D. Matrix NF NP I NP NP Preservations <br /> SP-I AIB 3123/99 soil 2 X X X X <br /> SP-2 A/B 3/23/99 soil 2 X X X X <br /> SP-3 A/B 3/23/99 soil 2 X X X X <br /> SP-4 A/B 3123/99 soil 2 X X X X <br /> SP-5 A/B 3/23/99 soil 2 X X X X <br /> SP-6 A/B 3/24/99 soil 2 X X X X <br /> SP-7 A/B 3/24/99 soil 2 X X X X <br /> SP-8 AIB 3/24/99 soil 2 X X X X <br /> SP-9 A/B 3124199 soil 2 X X X X <br /> SP-10 A/B 3/24/99 soil 2 X X X X <br /> WgnatUure <br /> UIS Jinatuk-- <br /> IV D BY RELINQUISHED BY RECEIVED B TURNAROUND REPORT REQUIREMENTS <br /> C"`"` REQUIREMENTS X 1. Routine Report <br /> Signature Signature 24 hr astir Sday It. Report(includes DUP,MS <br /> Harold Duke [ Q hAVMp�,v X Standard(—ID-I5workingdays) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Rmilts charged as samples) <br /> EMCON C r t 7 Provide FAX Prcharnnu <br /> �rrr� r RCtiOIt% Iff,Data Validation Report <br /> Firm Firm Requested Repon Dau (includes All Raw Data) <br /> '+/�•`r RW C3oaterrim Da /Tc Date/Time <br /> (MD s/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/comments: <br /> VOA <br /> Container Types Key <br /> ] <br /> Printed Name Printed Name ' <br /> Signature Signature 1) For oxygenates,analyze for MT13E TBA,MIT,ETBE,and TAME 250 4{1 ml l LFL: I <br /> using 8260 500 ml LPI:. 3 <br /> 1 liter HDPE. 4 I <br /> Composite A/B samples in lab for ONE analysis Firm Firm 500 mi glass: 5 <br /> 1 liter glass. 6 <br /> Daierl'imeDater[ime 2x6 s1s ring: 7 <br /> glass jar: 8 <br />