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M M M M M M M M ® M M M M M M ® ® M <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> 1T CORPORATION-1326 North Market Boulevard,Sacramento,CA 95834 IT P.O. No: 163841 <br /> (916)928-33110 FAX(9161928-3341 Lab: Se cola Analytical,Sacto <br /> Project Name: Foothill Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 791289 <br /> Project Manager: Steve Giacomini <br /> Company: IT CORPORATION <br /> Address: 1326 North Market Boulevard N <br /> Sacramento CA 95834 <br /> Phone: (916)928-3300 W c <br /> FAX: (916)928-3341 �. Z <br /> Sampler's Signature: U <br /> O <br /> SampleLAB Sample t 4 REMARKS <br /> I.D. Date Time I.D. ontainer Types <br /> D. Matrix . Hct NP Preservations <br /> MW-1 <br /> MW-2 1 water 4 3 1 <br /> MW-3 b 2 19M water 4 3 1 <br /> Field Blank Ifilh, water a a <br /> Trip Blank water 2 2 <br /> El <br /> REI,IN IIISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si re i i Si a 24 hr 48 w 5 my II. Report(includes DUP,MS <br /> X stenaard(-10-15 wodi%days) MSD,as required,may be <br /> &i Nal Prkted Nares Printed Name me NaProvide verbal Pretimhmy Resew charged as samples) <br /> l.. r X n CZ, L Provida PAX Pnlhn6ury Ruulu Ill,Data V lidation Report <br /> I'�1►u Firm Finn <br /> / m Firm Requester!Report nate: <br /> (inclu All Raw Data) <br /> X RWQCB' <br /> Dale/' ime SJZJJO 12-CR Dateriv.GIC7101 Date/Time Datelrime F (MDIs/PQLWTRACE#) <br /> RELINQ01SHEDBY RECEIVED BY Special Instruetions/Conunents: Container Types Key: <br /> Sequoia Analytical 40 A VOA: I <br /> Signaturo Signature Please report MDLa,PQIA and Trace. 819 Striker Avenue,Sto.8 250 nil LPE: 2 <br /> Nitrate-Nara=ea has a 48-hr.hold Sacramento,Ca 95834 500 ml LPE: 3 <br /> Printed Name Printed Name �y1% 916-921-9600 1 liter HDPE: 4 <br /> FinnFimt J l/ 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> Date/!'iote Datell'ime ' <br /> 2x6 s/s ring: 7 <br /> glassiar: 8 <br />