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CHAIN OF CUSTODY / 14ABORATORY ANAINSIS RFQ1JE'SI' FOR141 <br /> 1433 North Market Itoulevard,Sacramento, CA 95834 Service Request No: 1'mchasc(hdet: 05102251 <br /> smcon (916)928.3300 FAX (916) 928.3141 lab: 7nlax(805-544.4696) <br /> Project Name Port of Stockton Anal sis Requested <br /> Project Numb r. 20C42-001.026,Task 00 ® eu <br /> Project Manai cr: Charles Melzinger <br /> Company: E( ICON ' �" `O u Q °�� O 'e <br /> Address: 1435 North Markel Boulev ' e�lf$� x ct u <br /> S rcramenlo,CA 9 834 6' o V _r D 3 <br /> Phone: (916)918-33(10 U <br /> _�' o m W —yv., u ,U3 <br /> FAX: (916► 928.3341 - >v ll, ._ u t E <br /> Samplers Signature: _. -_ E v �Lt. U � •t? <br /> - — _ <br /> Z a O 3 REMARKS <br /> Santplc L.ABSamplc I 2 f. I Container Typ s <br /> I.D. Ua1c Time Lb. Matrix — nt'I 1100) n2So4 NI' Paservatinns <br /> PS /7w ZO y 4 /03 lad1� 3 water 3 2 .� <br /> PDrfw -!- 95-6— -31 — - - - - - - - - - - <br /> /4R 17w -S7A — <br /> Trtt P 6 9/2a/* 3r Z — <br /> O(—O-pl 9 /9) ._Y7 y I — <br /> X bLf -.Z7- <br /> f 2 wC-2 ti <br /> Izv 9� <br /> RF. 90RY R C 'IVF.0 RY RELINQUIS111•:1)BY 11151.'1•;1 VI•:U til' '1 Ili(NA ROUND FI. Rinnine <br /> llREgtl•:N'I'S <br /> RIS(2lIiRE�1F.N'1;S Rc nPnSt na ighaturo dSignawre Signature 24N _.tss, _saa, incltnks UUP.MS <br /> g -LLv h X sa,mm�Is.ro. u. n MSD,as ret erred,only <br /> 6e <br /> r r <br /> Primed`o a PrintedtNanne Primed Nana larinted Wine m�.u(•vcn.l ltirn..m.,r a�..0charged ne smnples) <br /> 6 7�� ml.;,Y rax nsummars as.iaa III.Data Validation Repan <br /> F / F ren <br /> y �l 221 f inn itnn <br /> y ,�- � �1� RnyrgcA rtrrym Uak: (irlclnJCs All Raw Data) <br /> RWQCD <br /> DatrTrne Dalefritne Uatdl'irnc Umdrime (A1ULs/1'QLs/rRAC'Eg) <br /> RELINQUISHED RY RECEIVED RY Spcdnl lnslmdinns/('nnu°f°'S0 Contairxr Tyles Key: <br /> 40 nd VOA: I <br /> .Signature Signature Lead is 0eld Rltercd. 250 til IIUPE: 2 <br /> Nape t'rinled Name C t\-O- ` ,Q c Sq)ml LPE: ) <br /> Printed Na <br /> t C l �1 �2��o�r- � 1 alo-9"1 25ain!VOA: 4 <br /> r� flrnn 500 ml gins: 5 <br /> 1 liter ph". I <br />