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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of— <br /> EMCON/OWT Inc. P.O.No: 211868 <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: 791289/00003000 <br /> b <br /> Project Manager: Steve Giacomini <br /> Company: EMCON/OWT Inc. <br /> Address: 1326 North Market Boulevard o00 <br /> Sacramento,CA 95834 �j <br /> Dir Ph: (916) 5654335 / FAX: (916)565-4356 0 U <br /> � z <br /> Sampler's Signature: 6 <br /> -- 1 66 <br /> Z F rn Z REMARKS <br /> Sample LAB Sample ` ,; a <br /> Container Types <br /> I.D. Date Time I.D. Matrix NP Preservations <br /> S-1 water 1 1 <br /> S-2 water 1 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 br _5day 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 Prelinmiary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time DatelTime DatelTime Date/Time (MDLs/PQLa/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> 40 mi VOA: I <br /> Signature Signature Please report MDLs,PQLs and Trace. Sequoia Analytical 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. 819 Striker Avenue,Ste.8 500 ml LPE: 3 <br /> Printed Name Printed Name Sacramento,Ca 95834 1 liter HDPE: 4 <br /> 916-921-9600 500 ml glass: 5 . <br /> Firm Firm Contact: Ron Chew 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Date/Time I glass jar: 8 <br />