Laserfiche WebLink
Rev.1/99 <br /> n CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 P.O.: <br /> 9ft1COn1 91 928-3300 FAX 91 928-3341 Lab: <br /> Project Name: Analysis Requested <br /> Project Number: <br /> Project Manager: <br /> Company: EMCON ° <br /> Address: 1433 North Market Boulevard ° <br /> U <br /> Sacramento,CA 95834 0 <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 E <br /> Sampler's Signature. z REMARKS <br /> Sample LAB Sample I 1containerTypes <br /> I.D. Date Time I.D. Matrix i. Preservations <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT RE,QLIIREMENTS <br /> REQUMEMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 Iv 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 Pravida Verbal Proliusinary Results charged as samples) <br /> Provide FAX Proliminary Results III.Data Validation Report <br /> Firm Firm Finn Finn Requested Report Date: (includes All Raw Data) <br /> RWQCB <br /> Date/Time Date/Time Date/Time Date/Time Ls/PQLs/TRACE# <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 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Date/Time glassjar. 8 <br /> FIGURE <br /> EMCONWATER SAMPLE FIELD DATA SHEET <br />