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M ® M w ® ® ® ® M M r r ® M ■r ® 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 (Lysimeters) <br /> Report to: Sheila Richgels <br /> <Sheila.Richgels@Shawgrp.com> c <br /> Company: EMCON/OWT Inc. <br /> Address: 1326 North Market Boulevard U r <br /> Sacramento,CA 95834 z <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 "o v co OD ' <br /> Sampler's Signature: a A U REMASignature: -0 <br /> KS <br /> Sample LAB Sample 1 4 3 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP HNO3 Preservations <br /> VZ-1 water 5 3 1 1 <br /> VZ-2A/13 water 5 3 1 <br /> VZ-3AB water 5 3 1 1 <br /> VZ-4AB water 5 3 1 1 <br /> VZ-5AB water 5 3 1 <br /> lu <br /> RELINQUISHED BY RECEIVED BY RELINQ SHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X_ I. Routine Report <br /> Signature Signature Si afore Signature 24 hr 48 hr 5 day e H. 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 Firth Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time <br /> (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RE IVSD BY Special Instructions/Comments: Container Types Key: <br /> Report MDLs,PQLs,and Trace.. Columbia Analytical 40 ml VOA: 1 <br /> Signature Signa 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 glass jar: 8 <br />