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CHAIN OF CUSTODY / LABORAggY ANALYSIS REQUEST FORM <br /> IT/EMC 1433 North Market,Boulevard,Sacramento,CA 95834 ervtce Request No Purchase Order <br /> (916)928-3300 FAX(916)928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Analysts Requested <br /> Project Number IT#792759122605-101 003 <br /> Project Manager Mark Capps N <br /> Company IT 1 EMCON Q <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 0 2- <br /> Sampler's Signature E <br /> � REMARKS <br /> Sample LAB Sam Pic l Container Types <br /> ID Pate_ Time ID Matrix FtC1 PresLrvatlons <br /> MW-1 water 3 3 <br /> MW-2 (1/ti water 3 3 <br /> I <br /> /717 <br /> RELI U S HY RE E RELINQUISIiED HY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> Sig tutlo rD Sign a Signature Signature 24 hr 49 lir s day It Report(includes DUP,MS <br /> ��/It�// Standard(-10 15 working days) MSD,as required,may be <br /> Pante me Print d ame Printed Name Printed Name Provide Verbal Preltmmary Results charged as samples) <br /> Provide FAX Prehintnary Rdults HI Data Validation Report <br /> Firiq /Oz) <br /> Firm Firm Requested Report Date (includes All Raw Data) <br /> (�, ( � 6Q/6 RWQCB <br /> Daterrime Date/rime Datefrime DawTime <br /> (MDLsIPQls/I 1tACE4) <br /> REI INQt11SHED BY RECEIVED BY Special Instructions/Cotnments Container Types Key <br /> Sequoia Analytical 40 ml VOA 1 <br /> Signalim. Signalure 819 Striker Avc,Sic 8 250 nil LI'E 2 <br /> S8ct0,Ca 95834 500 ml LYE 3 <br /> Printed Name Printed Name 916-921-9600 1 liter HDPE 4 <br /> Attn Ron Babel 500 ml glass 5 <br /> Fimi Firm I IltLr glass 6 <br /> 2x6 sls ring 7 <br /> Date/ inic Date/time glass jar a <br />