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m m m m m m m m <br /> CHAIN OF CUSTODY / LABORAXY ANALYSIS REQUEST FORM <br /> 1T 1 EMCON - 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: Purchase Order: Direct Bill USA <br /> (916)928-3300 FAX(916)928-3341 Lab: Sierra Analytical <br /> Project Name: USA Gasoline Station.465,Lodi,Ca Analysis Requested <br /> Project Number: IT#792065/20A41-008.001 <br /> Project Manager: Dave Foley. <br /> 0 ��0 <br /> Company: IT/EMCON <br /> Address. 1433 North Market Boulevard c o <br /> Sacramento,Ca 95834 U <br /> Phone: (916)928-3300 I 0 <br /> FAX: (925) 928-3341 <br /> Sampler's Signature: t o REEKS <br /> 00 <br /> Sample LAB Sample 1 Container Types <br /> I.D. Date Time I.D. Matrix HCl Preservations <br /> MW-1 3r `d 1150 $030. water 3 3 <br /> MW-2 I -z I 2 Soil water 3 3 <br /> MW-3 /L JZ_ F0321 water 3 3 <br /> MW-4 (`fgV33 water 3 3 <br /> MW-5 VO '703 Y water 3 3 <br /> MW-6 (O 00,035 water 3 1 3 <br /> MW-7 6, water 3 3 <br /> MW-8 X12_ 8037 water 3 3 <br /> S-1 ((¢ $0,3$ water 3 3 <br /> S-2 $Q 3r7 water 3 3 <br /> RELINQU1SIiE Y RELIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> � 5r REQUIREMENTS X L Routine Report <br /> Sigggure Signature Signature Signature 2410. 48 hr X Ill day II. Report(includes DUP,MS <br /> Tb M s u 12, Standard(-10.15 wwi*days) MSD,as required,may be <br /> Printed Name Printed Mame Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> l <br /> Provide FAX Preliminary Results Ill.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> � 3 to To tf-q-oo OT-3o RwQCB <br /> DateJTirne Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE4) <br /> RELINQUISHED'BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Sierra Labs 40 ml VOA: 1 <br /> Signature Signature 26052 Merit Circle,Ste.105 250 ml LPE: 2 <br /> Detection limits for MTBE by 826U need to Laguna Hills,Ca 92653 500 ml LPE: 3 <br /> Printed Name Printed Name be 0.5 ppb. 949-348-9389 1 liter HDPE: 4 <br /> Detection Limits for TBA must be Sppb. Rick Forsythe 500 ml glass: 5 <br /> Firm Firm Golden Stateq 14365 1 liter glass: 6 <br /> 2x6 s!s ring: 7 <br /> Date/Time Date/Time <br /> I <br />