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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of— <br /> EMCON/OWT Inc. Z050 <br /> Ido <br /> � P.O.# 74815 <br /> 1326 North Market Boulevar Sacramento CA 95834 Lab: CAS,Canoga Park,Ca <br /> Project Name:North County Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791288 (Ground Water) v <br /> Report to: Sheila Richgels ti s <br /> <Sheila.Richgels@Shawgrp.com> <br /> .� oo <br /> Company: EMCON/OWT Inc. <br /> Address: 1326 North Market Boulevard 0 <br /> Sacramento,CA 95834 0 0 ° c z <br /> Dir Ph: (916)565-4327 / FAX: (916)50-4356 110 z <br /> y N <br /> to L& <br /> w ^o <br /> Samplers Signature: a o v �j REMARKS <br /> Sample LAB Sample n 1 4 3 Container Types <br /> I.D. Date Time I.D.� Matrix `� HCl NP HNO3 Preservations <br /> G-1 qt ''A water 5 3 1 1 <br /> G-3D ��� water 5 3 1 1 <br /> G-4 fly`° water 5 3 1 1 <br /> G-5 epi. water 5 3 1 1 <br /> G-6i " water 5 3 1 1 <br /> Field Blank .b water 2 2 <br /> Trip Blank water 2 2 <br /> RELINQUISHED BY RECEIVES BY RELINSHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> �' '— �� ;i REQUIREMENTS X 1. Routine Report <br /> Si a Signature Signature Signatt}r ( za sr _as nr _5 day II. Report(includes DUP,MS <br /> J X Standard(-10-15 working days) MSD,as required,may be <br /> P Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Pmvide FAX Preliminary Result III.Data Validation Report <br /> IFirm Firm Firm _ .• Requested Report Date: (includes All Raw Data) <br /> WL <br /> � 1,/;t s � if X RWQCB <br /> Date/Time Date/Time Date rime Date/Time (MDLs/PQLs/i'RACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Report MDLs,PQLs,and Trace. Columbia Analytical 40 ml VOA: I <br /> Signature Signature Nitrate Nitrogen has a 48-hour hold time. 6925 Conaga Avenue 250 ml LPE: 2 <br /> Canoga Park,Calif 91303-3102 500 ml LPE: 3 <br /> Printed Name Printed Name Lab Contact: Karen Ryan 1 liter HDPE: 4 <br /> 818-587-5550 x310 500 ml glass: 5 <br /> Firm Firm Fx.818-587-5555 1 liter glass: 6 <br /> Ship FedX Acct 1435-1381-5 2x6 s/s ring: 7 <br /> Date/Time Date/Time I glass jar: 8 <br />