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I <br /> CHAIN OF CUSTODY / LABOR RY ANALYSIS REQUEST FORM , <br /> 01433 North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order <br /> 1MC011 (926)928.3300 FAX(916)928-3341 Lab Colu� mbia Anal tical <br /> Project Name Apache Plastics,Stockton Ana] s1s Requested <br /> Prujml Number, 22640-100.001 <br /> Project Manager Mark Capps W <br /> Company EMCON/Pinnacle <br /> Address 3939 Cambridge Road <br /> Cameron Park,Ca 95682 00 <br /> Phone (530)676-6881 �^ y <br /> FAX (530)676-6885 <br /> Sampler's Signature A-K00 <br /> x <br /> Sample Z r O REMARKS <br /> amp a <br /> ID Date Tune ID Matnx Container T s <br /> Preservations <br /> MW-8 `t g es Water <br /> MW-9 !337 water <br /> Rn=UIS1', <br /> HED Y RECEIVED BY <br /> RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> 5 cure Signature Signature Signature j� uhr 49 Ir shy II Report(includes DUP,MS <br /> Punted Name snadard(-tats�uttresdirf MSD as required maybe <br /> Printed Name Printed Name Printed Name PfMLe Verb l t'nt3nioary Resorts <br /> charged as samples) <br /> Pro%i&FAX FWmzbtuy Reruns III Data Validation Report <br /> i trot Firm Firm Frrtn atgmiW4 R t.n Date (includes All Raw pain) <br /> C a <br /> Dfi <br /> t rine Date/I"une Date/TuneDatrJTime kWtl( t)Ls Ls/iRACEM <br /> ) <br /> RELINQUISHED BY RECEIVED BY Special Instructlons/Commentat M&MConul►tcr tAC I(oy; <br /> Si awre Coltut�a�yu� 40 ml VOA 1 <br /> gn Signature 3334 Victor Court 250 ml LPE 2 <br /> Santa Clara,CA 95054 500 m1 LPE 3 <br /> Panted Name Panted Name 408-748-9700 1 ItterHDPE 4 <br /> rITM Firm 500rill glass 5 <br /> 1liter glass 6 <br /> Date/Tune DatcJl-uric 2x6 s/s ring 7 <br /> glass lar 8 <br />