Laserfiche WebLink
M M M ® M M ® ® M M M M M M <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> EMCON/OWT Inc. P.O.# 74815 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: CAS,Canoga Park,Ca <br /> Project Name:North County Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 791288 (Surface Water) <br /> Report to: Sheila Richgels <br /> <Sheila.Richgels@Shawgrp.com> s <br /> Company: EMCON/OWT Inc. a <br /> Address: 1326 North Market Boulevard U ao <br /> Sacramento,CA 95834 4. O v a Z <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 <br /> w <br /> Sampler's Signature: <br /> W L Q U U c REMARKS <br /> Sample LAB Sample 1 4 Container Types <br /> I.D. Date Time I.D. Matrix Hal NP HNO3 Preservations <br /> S-1 water 6 3 2 1 <br /> S-2 water 6 3_.�L 2 1 <br /> S-4 water 6 3 2 1 <br /> RELINQUISHED BY RECEIVED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Sign re Signature Signature 24 hr 48 hr 5 day 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 Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> RWQCB <br /> Date/Time Date/Time Date/time Date/Time X (MDLs/PQLs/TRACE#) <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-hr hold time. 6925 Conaga Avenue 250 nil 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 nil 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 />