Laserfiche WebLink
Rev,1 99 <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 P.O.: <br /> Emto0 916 928-3300 FAX 916 928-3341 Lab: <br /> Project Name: Analysis R uested <br /> Project Number: <br /> Project Manager: <br /> Company: EMCON <br /> G <br /> Address: 1433 North Market Boulevard v <br /> Sacramento,CA 95834 0 <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 E <br /> Sampler's Si natu . s' I I REMARKS <br /> Sample LAB Sample Container T es <br /> I.D. Date Time I.Q. Matrix in Preservations <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signature Signature Signature Signature 24 hr 48 h_ s day IL Report(includes DUP,MS <br /> Standard(-10-1$working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Varbat Praumiaary Rwria charged as samples) <br /> Provido FAX ProiiminaryRmits 11).Data Validation Report <br /> Firm Firm Firm Firm Roquostad Report Data: (includes All Rare Data) <br /> RWQCB <br /> Datefrime DaiePrime Date/Time Date rime L Ls/MCE# <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 1 liter HDPE: 4 <br /> 500 mi glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Datelrime glass jar: 8 <br /> FIGURE <br /> 00 EAMWICON WATER SAMPLE FIELD DATA SHEET -3 <br />