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M6433 CHAIN OF CUSTODY 1 LABORATORY ANALYSTS REQUEST FORM <br /> 433 North Market Boulevard,Sacramento,CA 95834 Servi0quest No: Purchase Order: <br /> IEM (916)928-3300 FAX (916)928-3341 t)0 �1 7 Lab: CA S <br /> i Project Name:Teichert & Sons,Stockton Analysis Requested <br /> Project Number: 201190-002.007 <br /> Project Manager: Matt Turner <br /> Company: Pinnacle v 00 <br /> Address: 3939 Cambridge Road,Suite 220 Co C> C) w o <br /> a <br /> 00 <br /> Cameron Park,CA 95682 0 Q d Q � <br /> Phone: (530)676-6884 4. w W W -rA <br /> Cn U)FAX: (530)676-6885 ° &0 <br /> Sampler's Signature: _ 0 <br /> Z F H A�0 10 [-� REMARKS <br /> Sample LAB Sample container Types <br /> I.D. Date Time I.D. Matrix Preservations <br /> TK-8E 3123199 M soil l X X X X <br /> TK-8C 3123199 15:25 soil 1 X X X X <br /> TK-8W 3123199 15:30 soil 1 X X X X <br /> DS-1 (35) 3124199 9:50 soil 1 X X X X <br /> DS-2 (3.5') 3124199 9:45 soil 1 X X X X <br /> PL-1 (3.5') 3124199 9:55 soil 1 X X X X <br /> 0-1 <br /> REL Qt QY R CEIVE i BY Cly R'sLINQUISHED BY RECEIVED BY d TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS/ X 1. Routine Report <br /> Signature 10P14 <br /> u,�,� Signature Signature 24 br 48 hr �C s lay Il. Report(includes DUP,MS <br /> Harold Duke f/SLI Standard(-30.15 wor(my dAy) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Prelunmary Resxdts charged as samples) <br /> EMCON VST Provide FAX Prelimmary Result, Ill.Data Validation Report <br /> Fir /tgk <br /> Fir qAFirm Firm Requtsted Rcpon Dale (includes All Raw Data) <br /> f ; %l '[� RWQCH <br /> ate'..e Date/Ti a Date/Time Date/Time <br /> (MDLs/PQLsfTRACEN) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: t f /r ri Container Types Key: <br /> 40 ml VOA: I <br /> Signature Signature 1) For oxygenates,analyze for MTB EJTA,DIPS,[--'FB E,and TAME 250 ml LPE: 2 <br /> using 8260 500 ml LPE: 3 <br /> Printed Name Printed Name 2) if total lead by 7420 is greater than 50 ppm,then analyze for total lead by 7421 l liter HDPE: 4 <br /> ! f l l 1 r 500 mf glass S <br /> �A' <br /> Firm Firm .� 1 r�� ST <br /> f� J 1 l liter glass: 6 <br /> 2x6 s!s ring: 7 <br /> Daterrime Date/Time <br /> glassjar: 8 <br />