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CHAIN OF CUSTODY / LABORA*Y ANALYSIS REQUEST FORM = <br /> CW63 North Market Boulevard,Sacramento, CA 95834 Service Request No <br /> Purchase prder con (9i6}928-3300 FAX (916) 928-3341 J <br /> _ <br /> Project Name IBC-Stockton Lab SEQUOIA <br /> Project Number 22605-101001 Ana! s1s Re nested <br /> Project Manager Deanna Santos o <br /> Company EMCON-Pinnacle Cq0 <br /> Address 1433 North Market Boulevard <br /> C> <br /> Sacramento,CA 95834 0 1ca <br /> Phone (916)928-3300 U X 3 N <br /> FAX (916)928.3341 ° o v 00,, <br /> Sampler's Signature <br /> x � <br /> Sample LAB Sample r 1 I 4 REMARKS <br /> ID Date Time ID Matrix HCl Container Types <br /> HCI <br /> MW-I -��9r L 1- water 5 3 Prescrvauons <br /> 2 <br /> MW-2 8-�i_sy l3Z 4 water 5 3 2 <br /> RELINQUISHED BYRECEIVED BY RELINQUISHED BY <br /> RECEIVED BY TURNAROUND REPORT REQUIREMENTSSignatures- Slgnawrc Signature Signature REQUIREMENTS X I Routine Report <br /> 24 hr 49 he 5day II Report(includes DUP MS <br /> Pr l d 'e Printed Name X Standard(-lfi 15 working days) MSD as required may be <br /> / Printed Name Printed Nalne <br /> •; , n PnevidC Verbal Prdrmrnary Rcaalta charged as samples) <br /> Fi nnCON Finn Firm Finn Pfowde FAX Prehmmary Rnulti 111 Data Validation Report <br /> Requemed Repiri Dare <br /> Date/Time (includes All Raw Data) <br /> f/z-9Y b'a� Daielrime DaterrimeRWQCB <br /> RELINQUISHED BY Date/Time <br /> RECEIVED BY Special Iaslructions/Commtnls (MULs/PQLsfrRACEp) <br /> Container Types Key <br /> Signature Si re Sequoia Analytical 40 ml VOA I <br /> 819 Striker Ave Sic 8 250 ml LPE 2 <br /> Printed Name F <br /> ted N me Sacro Ca 95834 500 ml LPE 3 <br /> rh mQrCy aLl t� 916 921-9600 1 liter HDPE 4 <br /> Frm 500 ml glass 5 <br /> a I liter glass 6 <br /> Date/Time Datelrlm — - 20 s/s ring 7 <br /> glass ar 8 <br />