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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page I of l <br /> EMCON/OWT Inc. P.O. No: 189780 for 2002' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab: Sequoia Analytical,Sacto <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791289/00004000 <br /> b <br /> Project Manager: Steve Giacomini H ^o <br /> Company: EMCON/OWT Inc. <br /> Address: 1326 North Market Boulevard `O En 00 <br /> � N v <br /> Sacramento,CA 95834 �j Q <br /> Dir Ph: (916)565-4335 / FAX: (916)565435 o W a <br /> P <br /> Lu— <br /> Sampler's Signature: .a U <br /> En <br /> Z > REMARKS <br /> Sample LAB Sample 1 4 1 1 Container Types <br /> 1.D. Date Time I.D. Matrix liel NP Preservations <br /> MW-3 water 1 4 3 1 <br /> Field Blank tJIA water 2 2 <br /> Trip Blank water 2 2 <br /> �.5Go <br /> RELINQIIISIIED 111' RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> WJ <br /> Si r t re f Signature Signature 24 hr 48 hr _5day II. Report(includes DUP,MS <br /> , `,(i, L X standard(-10-15 worldng days) MSD,as required,may be <br /> PriAt <br /> ame Printed Name n pPrinted Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> L. (,ICJ I� /"�! Q� 1 t n/i C r, �1 f.S Provide FAX Preliminary Results II1.Data Validation Report <br /> Fitnt Finn Firm Firm Requested Report Date: (includes All Raw Data) <br /> 6�p <br /> r�,7Lv X 12WQCF3 <br /> DateTl'inie 0,/4,,p7_ Date/Tine 10 1 OZ (:IS Date/Time Date rime (MDLs/PQIsfl'RACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Continents: Container Types Key: <br /> Sequoia Analytical 40 nil VOA: I <br /> Signature Signature Please repoll MDIs,PQLs and Trace. 819 Striker Avenue,Ste.8 250 nil Li'l,: 2 <br /> Nitrate-Nitrogen has u 48-hr hold time. Sacramento,Ca 95834 500 nil LPI-: 3 <br /> Printed Name Printed Name 916-921-9600 1 liter HDPE: 4 <br /> Contact: Ron Chew 500 ml glass: 5 <br /> Firm Firm l liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date"rimcI)aI—tnt t <br /> _ ss iariiiiiiiiiiiiiiiiiii A111111111111111111 <br />