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0 0 Res <br /> CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM <br /> 00 1433 North Market Boulevard,Sacramento,CA 95834 P.O.: <br /> EIIIICOIt (916)928-3300 FAX(916)928-3341 Lab: <br /> Project Name: Analysis Requested <br /> Project Number: r2 <br /> Project Manager: (D <br /> Company: EMCON <br /> Address: 1433 North Market Boulevard 0 <br /> Sacramento,CA 95834 16 <br /> Phone: (916)928-3300 - <br /> FAX: (916)928-3341 E <br /> Sampler's Signatute._ z I IREMARKS <br /> Sample LAB Sample <br /> I lcontainer T <br /> I.D. Date Time I.D. Matrix Preservations <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 101 <br /> 1 101 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 br-49 hr— 3 day 11. Report(includes DUP,MS <br /> X Standard(-10-13 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 111,Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> RWQCB <br /> Date/Time Date/Time Date/Time iDate/Time (MDLs/PQLs/TPACE#), <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> 40 ml VOA: I <br /> Signature Signature 250 ml LPE: 2 <br /> 500 ml LPE: 3 <br /> Printed Name Printed Name I liter HDPE: 4 <br /> A— 500 ml glass: 5 <br /> 1 <br /> Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> rD'a,7/T—..e— JDate/Time glass jar8 <br /> FIGURE <br /> k ;3 <br /> ERACON WATER SAMPLE FIELD DATA SHEET A-3 <br /> own <br />