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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of— <br /> IT/EINICON - 1433 North Market Boulevard,Sacrament(►,CA 9.5834 Service Request No: � <br /> q IT P.O. No: 135417 OP <br /> (916)928-3300 FAX(916)928-3341 <br /> Project Name: Foothill Landfill,San Joaquin County Lab: Sequoia Analytical <br /> Project Number: 1T#791289 Analysis Requested <br /> b <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON !�► <br /> Address: 1433 North Market Boulevard N00 <br /> Sacramento,CA 958340 00 <br /> Phone: (916)928-3300 w a G a <br /> o Wo <br /> FAX: (916)928-3341 w 't, <br /> Sampler's Signature: rn U <br /> U <br /> ., REMARKS <br /> Sample LAB Sample ; I a container Types <br /> 1.D. D to Time I.D. Matrix ' iICI NP <br /> MW-1 a water 4 3 1 - Preservations <br /> U <br /> MW-2 O water 4 3 1 <br /> MW-3 water 4 3 1 <br /> Field l; water 3 3 <br /> LI I ?D BY ---1 l--T <br /> RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND <br /> REPORT REQUIREMENTS <br /> Sl rq ,� <br /> REQUIREMENTS X 1. Routine Report <br /> J, t7 gn Signature Signature 24 hr 481u 5 day 1I. Report(includes DUP,MS <br /> Printed <br /> _ X Starldard(-to-t 5 wodijig days) MSD,as required,may be <br /> Printed Name Printed Name Provide verbal Pretinunary Results charged as samples) <br /> FirmProvide FAX PrelutunatyResults III.Data Validation Report <br /> ��pp S Ftrtn �y Firm Ftretn Requested Report Dale: <br /> o% !� (includes All Raw Data) <br /> X RWQCB <br /> Dale/Timu Date/Time Date/Time Date/Time <br /> RELINQUISHED BY (MDts/PQIsaRACE#) <br /> Q RECEIVED BY Special Instructions/Conunc nts: <br /> Container'1'ypes Key: <br /> Sequoia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report HDLs,PQLs and Truce. 819 Striker Avenue,Ste.8 <br /> 250 ml Ll'E: 2 <br /> Nitrate-Nitrogen has a 48-hr hold fink' Sacramento,Ca 95834 500 ml L,PIs: 3 <br /> Printed Name Printed Name <br /> 916-921-9600 1 liter HDPE: 4 <br /> Firm Finn 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> 1):de°rim.: Datei Time 2x6 sin ring: 7 <br /> glass jar: 8 <br />