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CHAIN OF CUSTODY 1 LABORAT ANALYSIS REQUEST FORM <br /> � i <br /> North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order Risk Mngt SJ(888-234-7475) <br /> si;IIMCOIn (916)928-3300 FAX (916)928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Analysis Requested <br /> Project Number 22605-101001 <br /> Project Manager Deanna Santos o <br /> Company EMCON-Pmnacle 00 <br /> Address 1433 North Market Boulevard <br /> Sacramento,CA 95 t j o <br /> Phone (916)928-3300 L.- 0 N 3 � <br /> 0 00 <br /> FAX (916)928-3341 OD A <br /> Sampler's Signature <br /> a, <br /> z o w REMARKS <br /> Sample LAB Sample 1 1 ContamerTypes <br /> I D Date Time I D Matrix = 6 HCl HCl Preservations <br /> MW-1 4,3 i�i3 water 5 3 2 <br /> MW-2 water 5 3 2 <br /> i <br /> -EFEI <br /> RE N I D BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> Si namr Signature Signature Signature 24 to 4e hr 5 Jay It Report(includes DUP,MS <br /> #aoX SunJanl 15 wnrlungJays) MSD,as required,may 6e <br /> 1PAted Nainq Printed Name Pnnted Name Printed Name Provide vcdW Prchmnury R�iis charged as samples) <br /> M (� PnividcFAX Preliminary Resuiu III Data Validation Report <br /> �Jf <br /> Finn Firm Firm Reyuesw Repon Dau (includes All Raw Data)r RWQCB <br /> Dat rme Date rime Daterrime jDaterfmae <br /> (M DLsIPQLs/fRACE#) <br /> RELINQUISHED BY IVED BY Special InstructionVComments Coniamer Types Key <br /> Sequoia Analytical 40 ml VOA 1 <br /> Signature Sig 819 Sinker Ave,Ste 8 250 ml LPE 2 <br /> -- — , &.10 Sacto,Ca 95834 500 ml LPE 3 <br /> Printed Name Printed Nairn 916-921-9600 l liter HDPE 4 <br /> t0 0, rp 500 ml glass 5 <br /> Ficin <br /> N <br /> l liter glass 6 <br /> NJ2x6 sls nng 7 <br /> Darilrrmc Daft1tifne glassiar 8 <br />