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CHAIN.—OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page •of <br /> EMCON/OWT Inc: P.O. 211132 <br /> 1.326 North Market Boulevard,Sacramento,CA 95834 Lab: Sequoia Analytical,Sacto <br /> Project Name:Corral Hollow Landfill,San Joaquin County Analysis Requested <br /> Project Number. 791291/00002000 a <br /> Project Manager: Steve Giacomini <br /> Company: EMCON/OWT Inc. <br /> Address: 1326 North Market Boulevard 00 <br /> Sacramento,CA 95834 c �' <br /> Dir Ph: (916)565-4335/FAX ( 6)56 4356 0 0 y <br /> Sampler's Signature: z04 0 <br /> A b t° a° c� S . REMARKS <br /> �P e L Sample ' 'c. 4 1 125 LPE Container Types <br /> I.D. Date Time I.D. Matrix ;fix; owder <br /> NP HCI P Preservations <br /> MW-4 -1:0 IOCIZ- water 5 1 3 1 <br /> 1 <br /> 1 <br /> • 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Sign Signature Signature Signature 24 hr 48 hr5 day II. Report(includes DUP,MS <br /> MMUCA Standard(-10-15 working days) MSD,as required,may be <br /> rin d Naqe Pnntc4Varne Printed Name Printed Name Provide Verbal Preliminary Recaps charged as samples) <br /> �- �► I� Provide FAX Preliminary Molls III.Data Validation Report <br /> Firm Film Firm Firm <br /> S� ) j��.^ Requested Report Date (includes All Raw Data) <br /> DatelTime W G �„ X RWQCB <br /> "r-26-+rZ$ DatwT a -) 00 Date/Time Date/time (11IDLs/PQL VTRACE#) <br /> RELINQUISHED BY RECEIVEDY Special Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 819 StrilrerAvenue,Suite 8 250 ml-LPE: 2 <br /> Nitrate Nitrogen has a 48-hr hold time. Sacramento;Ca 95834 500 ml LPE: 3 <br /> Printed Name Printed Name Fecal Coliform samples need to get to the lab within 4 hrs! 916.921-9600 1 liter HDPE: 4 <br /> Contact: Ron Chew <br /> Firm Firm 500 ml glass: 5 <br /> I liter glass: 6 <br /> Date/time DatelTime 2x6 s/s ring: 7 <br /> glass jar: 9 <br />