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CHAIN OF CUSTODY I LABORA&RY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order <br /> EMCOn (916)928-3300 FAX(916)928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Analysts Requested <br /> Project Number 1T#792759/22605-101003 <br /> Project Manager Mark Capps N <br /> Company IT/EMCON <br /> Address 3939 Cambridge Road,Suite 220 <br /> 00 <br /> c 0' <br /> Cameron Park,CA 9682 0 <br /> Phone (530)676-6881 w w N <br /> FAX (530)676-6885 ° o <br /> Sampler's Signature 1.4 <br /> _ z <br /> z E-• REMARKS <br /> Sample LAB Sample i Container Types <br /> I D Date Time 1 D Matrix HC1 Preservations <br /> MW-1 8 /it water 3 3 <br /> M W-2 /S water 3 3 <br /> RELINQIIISIIEDLBY RECEIVED BY REI INQ11ISIIFD BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S I urL 11 SignaJulr tgnature Signature 24 hr 48 hr 5day 11 Report(includes DUP,MS <br /> X Standard(-10 l5.61n8 days) MSD,as required,may be <br /> Printed Name Prm d Name 14Printed Name Printed Name Provide Verbal Prehm�nary Results charged a5 samples) <br /> } "'4 Pronde FAX Preliminary Results Ill Data Validation Report <br /> Firm Flrnl/' Film firm R <br /> squem d Report P� Date (includes Al!Raw Data) <br /> tu/ rI I RWQCS <br /> Date/Time Date lFim DatelFime DatelFime <br /> (MDI.slPQLslFRACEH) <br /> RE(INQUISHED BY RECEIVEDIRY Special Instructions/Comments Container Types Key <br /> Sequoia Analytical 40 ml VOA i <br /> Signature Signature ; 819 Striker Ave,Ste 8 250 ml LPE 2 <br /> Sacto,Ca 95834 500 ml LPE 3 <br /> Printed Name Printed Name r 916-921-9600 1 liter HDPE 4 <br /> Attn Ron Bobel 500 ml glass i 5 <br /> Firm Finn <br /> 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> Date/Time I Date/Time glasslar 8 <br />