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' CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> /,MCON/OWT Inc. P.O. 211132 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: Sequoia Analytical,Sacto <br /> Project Name: Corral Hollow Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 791291/00004000 5 <br /> Project Manager: Steve Giacomini 2 6 6 <br /> Company: EMCON/OWT Inc. 00 c �j P-4 ok O o <br /> Address: 1326 North Market Boulevard :d � v :*; oo b Z �, w <br /> Sacramento,CA 95834 v _ �, U <br /> Dir Ph: (916)565-4335/FAX: (916)565-4356 a o b a M 4 .N o O v '5 <br /> Z v <br /> U N en p 5 x b 3 S <br /> Sampler's Signature: `>�--s-- �; O0 " U °0 0 u-, <br /> � Q � � Q o .c � a � <br /> Z � REMARKS <br /> U <br /> C1 W U �'' �H ri W U .Ni � ri �''. � z' <br /> Sample LAB Sample ;%'; +;` 4 1 3 1 6 3 2 4 4 Container Types <br /> I.D. Date Time I.D. Matrix NP HCl HNO3 H2SO4 NP NP NaOH Pres. HNO3 Preservations <br /> MW4 0,6-0 f 1 water 5 1 3 1 <br /> MW-5 /0-b-4 t 114< water 1 3 1 <br /> SB-1 ws-o (3)-? water 1 3 1 <br /> MW-6 /6- L water 1 1 3 3 5 1 oR 1 1 <br /> MW-7 ha-£s--63 /Y 3< water 1 1 3 3 5 1 1 1 <br /> Field Blank /c,—;6� 11tJ q 57 water 2 2 <br /> Trip Blank 1a- / water 2 2 <br /> RELINQUISHED BY EIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Si natur p Signature Signature 24 hr 49hr 5 day 11. Report(includes DUP,MS <br /> �j�(,.CO►v1 tVy "� C. X Standard(-10.15 working days) MSD,as required,may be <br /> Printed Name Pr' ted Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Gli�1 Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Fi R, Firm Firm Requested Report nate: (includes All Raw Data) <br /> O55 <br /> X RWQCB <br /> Date/Time Date/time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Please report MDLs,PQLs,and Trace. Sequoia Analytical 40 ml VOA: I <br /> Signature Signature 819 Striker Avenue,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 Chrom VI has a 24-hr HOLD TIME 916-921-9600 1 liter HDPE: 4 <br /> **Metals: Al,Sb,Ba,Be,Cd,Cr,Co,Cu,Ag,Sn,V,Zn, Contact: Ron Chew 500 ml glass: 5 <br /> Firm Firm Fe,Mn,As,Pb,Hg,Ni,Se,Ti,Ca,Mg,Na,K(Field Filtered). i liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Date/Time glass jar: 8 <br />