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• <br /> CHAIN OF CUSTODY / LABORATRY ANALYSIS REQUEST FORM <br /> 0 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 Anal sis Requested <br /> Project Number 22605-101001 <br /> Pi Ojet,t Manager Claudio Avila r t o <br /> o <br /> Company EMCON r ,°�„° <br /> Address 1433 North Market Boulevardo � <br /> Sacramento,CA 95834 U <br /> Plume (916)928-3300 ``0" � y o <br /> FAX (916)928-3341 <br /> Satnpl4r's Signature z O REMARKS <br /> Sampha LAC3 Sample i i ContatnerTypes <br /> ID Dale Tirne I D Matrix HCI HCI Pres,rvations <br /> MW-I &k F oto water 5 3 2 <br /> MW-2 to water 5 3 2 <br /> I <br /> REI NQ111 Iib D B3 ,4 RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> !�� REQUIREMENTS X 1 Routine.Report <br /> I Lire Signature Stgnaturr Signature 241tr 491ha 5day It Report(includes DUP MS <br /> r CI (Q�S X Standard(-In 15working Jsys) MSD as required,maybe <br /> PlrElil�l�N�31�I11/ Pnii[.-l Naint. Pnnt�d Natu� PnntM Name Prnwd,Verna]Pn ILminary Ruuf� chargr d as samples) <br /> Provide FAX Prelimm.uy Results 111 Data Validation Report <br /> Ft Finn Ftmi Finn ReyuesreJ Rein Dare (includes All Raw Data) <br /> v� / RWQCB <br /> Date/Tnne / Datc(rune Date./rdme DatJI ime (MDLs/PQLsrrRACE#) <br /> RI1I INQUIS111:D BY RECEIV D Y pectal Instructions/Comments Container Types Key <br /> C 40 ml VOA l <br /> SEgnatun ignature 250 ml LPE 2 <br /> 500 ml LPE 3 <br /> I liter HDPE 4 <br /> Prints d N,ult. P d Name <br /> � 500 ml glass 5 <br /> 7-00 FFQ l 1 liter glass 6 <br /> Finn i ji O 1 <br /> 2x6 sIs ring 7 <br /> glass}ar <br /> DatL/Ttrn� D i c./rdnit, B <br />