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CHAIN OF CUSTODY/ LABORARY ANALYSIS REQUEST FORM <br /> Q t <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request Na Purchase Order #5302234 <br /> Eroeon (916)928-3300 FAX(916)928.3341 Lab Sequoia <br /> Project Naine IBC-Stockton Anal sis Requested <br /> Project Number 22605-101001 <br /> r-, <br /> Project Manager Claudio Avila <br /> Company EMCON m <br /> Address 1433 North Market Boulevard o <br /> Sacramento,CA 95834 �y <br /> Phone (916)928-3300 <br /> FAX (916)928-3341 a <br /> Sampler's Signature E x <br /> z REMARKS <br /> Sample V LAB Sample I Container Types <br /> I 1) Date Time I D Matrix HCI Preservations <br /> M%V-l Wa(cr Z# -2,a - <br /> WV-2 3�'��'y,' lyo y water 24 :4 <br /> Qt 8H)KD BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S eat Signature Signoure Signature 24 hr 49 M s day If Report(includes DUP.MS <br /> rr7�7 X sand"(-11"5 wwkmi days) MSD,as required,may be <br /> Pnntt.d Nam�y Printed Namme e Printed NaPrinted Name arwi&VcdW Ftei�mua y limits charged ua samples) <br /> 0 <br /> L{/f inmde FAX erwmiftay Rcaudu III Data Validation Report <br /> FirmFinn Firm Firm iu4aeumt Rcpwr Dau (includes All Raw Data) <br /> $ Z <br /> /Z Ic)7 c)00 RWQCB <br /> Date/Tune Damrrurie Datelritne Daterrime (M DL.1PQL.TR ACE#) <br /> RELINQUISHED BY :— R CEI BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature Signal 250 ml LPE 2 <br /> u 500 ml LPI? 7 <br /> Printed Name Printed Now I liter HDPE 4 <br /> t 6, 500 ml glass 5 <br /> Finn 4F _ 1 liter glass 6 <br /> ydW s/s ring 7 <br /> DalLfftmc ric -1 1 glasslar 8 <br />