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® r rr r rr rr r r rr r r rr r ® ® r <br /> CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> EMCON/OWT Inc. P.O. 211132 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: Se uoia Analytical,Sacto <br /> Project Name:Corral Hollow Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791291/00002000 <br /> Project Manager: Steve Giacomini �, o <br /> Company: EMCON/OWT Inc. O- <br /> To <br /> 1326 North Market Boulevard <br /> Sacramento,CA 95834 U iu t~ o C <br /> Dir Ph: (916)565-4335 / FAX: (916)565-4356 0 0 0 Z <br /> U z as <br /> Sampler's Signature: 0 q� � U w <br /> z 1- T 0 <br /> z U > U REMARKS <br /> Sample LAB Sample 4 1 1 Container Types <br /> I.D. Date Time I.D. Matrix NP HCl BN03 Preservations <br /> SW-1 water 5 1 3 1 <br /> SW-2 water 5 1 3 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I, Routine Report <br /> Signature Signature Signature Signature 24 hr 48 hr 5 day II. Report(includes DUP,MS <br /> X Standard(-10.15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <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 /> Sequoia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 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 916-921-9600 1 liter HDPE: 4 <br /> Contact: Ron Chew 500 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Date/Time I glass jar: 8 <br />