Laserfiche WebLink
viiiiiii , 11_ I 111111111111, IllllllIIN � 1_ ]_ 1111111- 111_ � � 1111111111111' ll_ ]_ <br /> CHAIN OF CUSTODY 1 LABORAT Y ANALYSIS REQUEST FORM <br /> IT 1 EMCO 433 I�Iorth Market Boulevard,Sart ameato,CA 95834 ice Request No Purchase Order - <br /> (916)928-3300 FAX(916) 928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Analysts Requested <br /> Project Number 1T#792759122605-101 003 <br /> Project Manager Mark Capps o <br /> Company IT/EMCON <br /> Address 3939 Cambridge Road,Suite 22 <br /> Cameron Park,CA 968 0 <br /> Phone (530)676-6881 U X N <br /> FAX (530)676-6885 ° 000 <br /> Sampler's Signature w <br /> a x <br /> z REMARKS <br /> Sample LAB Sample ] Container Types <br /> I D pae 1 ime I D Matrix I HCl Preservations <br /> MW-1r water 3 3 �- <br /> MW-2 ,Lti water 3 3 <br /> RELI U Sry BY RE E RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENT S X 1 Routine Report <br /> Stturp vw S I jr—ij Signature Signature 24 hr ae he s day 11 Report(includes DUP,MS <br /> X srandard(-rays Working days) MSD,as required,may be <br /> Printed me Print d _ame Printed Name Printed Name Provide Verbal Preliminary Resurta charged as samples) <br /> Provide FAX Prehminmy Results ill Data Validation Report <br /> FrnSt r �� !J I rim r C C�J1 a Finn Finn Requested Repon Date (includes Ail Raw Data) <br /> (�, J RWQCB <br /> Date/Time Date/Time Daterrime 1)ate/Ttme <br /> (MDLs/PQl.sfl RAC1;#) <br /> RELINQUISHED BY RECEIVED BY Special Instructiuns/Comments Container Types Key <br /> Sequoia Analytical 40 nil VOA 1 <br /> Signator, Signature 819 Striker Ave,Sir. 8 250 in]I PE 2 <br /> Sauo C. 95834 500 irrl 1_PE 3 <br /> Printed Mame Printf d Name. 916-921 9600 1 lrti r IIDPE 4 <br /> Atin Run Robe] 500 all glass 5 <br /> 1 tmi [urn I liter glass 6 <br /> 2x6 s/s ring 7 <br /> Date!€ung T)atr Rime _ gldsS lar 8 <br />