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CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_of <br /> EMCON/OWT Inc. -fir--;- P.O.# 74815 <br /> 1326 North Market Boulevard Sacramento CA 95834 / Lab: CAS,Canoga Park,Ca <br /> Project Name:North CuuntyLandf San 1 acl County Analysis Re uested <br /> Project Number: 791288 (Leachate) <br /> Report to: Sheila Richgels <br /> <Sheila.Richgels@Shawgrp.com> <br /> Company. EMCON/OWT Inc. B <br /> Address: 1326 North Market Boulevard 0 <br /> Sacramento,CA 95834 c 0 <br /> Dir Ph: (916)565-4327 / FAX: 916)565-435 z <br /> b J °1 <br /> R � <br /> Sampler's Signature: °- = _ <br /> ua z v , _ 1. REMARKS <br /> Sample LAB Sample r'.: 1 4 3 Container Types <br /> I.D. Date Time I.D. Matrix HClNP 17 HNO3 Preservations <br /> water 5 3 <br /> L-3 water 5 3 `l I <br /> L-4 v-!l j sa.r " water 5 3 ' 1 1 <br /> AV <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY ! RECEIVED)AY TURNAROUND REPORT REQUIREMENTS <br /> r ' j'( 1' REQUIREMENTS X 1. Routine Report <br /> Si t e Signatur Signa r--� Si ture f , i 24 hr 48 hr _5 day 11. Report(includes DUP,MS <br /> —7—Standard(—lo-ts ort ns days) MSD,as required,may be <br /> P,i,nlfd Name -ted Name Printed Name Printed Na;, Provide Verbal Preliminary Results charged as samples) <br /> -. 1"JaPrmide FAX Preliminary Results 111.Data Validation Report <br /> Fi. Firm Firm Firm, Requested Repon Date: (includes All Raw Data) <br /> X RWQCB <br /> Date,?ime Jv., ;fit%DatctTime Date/Time Date/Time (MDLs/PQLs,TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Report MDLs,PQLs,and Trace. Columma Analytical 40 ml VOA: 1 <br /> Signature Signature Nitrate Nitrogen has a 48-hoar hold time. 6925 Conaga Avenue 125 ml LPE 2 <br /> Canoga Park,Calif 91303-3102 500 ml LPE: 3 <br /> Printed Name Printed Name Lab Contact: Karen Ryan t 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 glass jar: 8 <br />