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CHAIN <br /> OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard, Sacramento,CA 95834 Service Request No S 84011 10 Purchase Order <br /> sEmcon (916)928-3300 FAX(916) 928-3341 Lab Columbia Analytical <br /> Project Name Apache Plastics,Stockton Analysis R uested <br /> Project Number 22640-100 001 <br /> Project Manager Mark Capps <br /> Company EMCON/Pinnacle W <br /> Address 3939 Cambridge Road Q <br /> Cameron Park, Ca 95682 0 <br /> Phone (530) 676-688I <br /> FAX (530)676-6885 _ <br /> �! o <br /> Sampler's Signature <br /> z00o REMARKS <br /> ainpie LAB Sample �, Container Types <br /> I D Date Time I D Matrix <br /> Preservations <br /> I MW-$ `t � 4 v � water <br /> MW-9 L 133? water <br /> !RE2L ,Q,1-1ISHED, Y RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> Si azure I fA REQUIREMENTS X 1 Routine Report <br /> 7 n Signature 6 Signature Signature 24hr 48nr 5 day II Report(includes DUP,MS <br /> Ca J4✓J ��� Siazdazd(-10.15 working days) MSD as required may be <br /> Panted Name Panted Name <br /> Panted Name Panted Name Provide Veinal Pro[ <br /> C S muy WLs charged as samples) <br /> Finn Firm <br /> Provide FAx Prelsmarary Rcsdn III Data Validation Report <br /> 4 f'.3 I gq ?r,,.2 Firm Requested Repon Daae ) <br /> ! (includes All Raw Data <br /> HMDLs/PQLsfIRACE4) <br /> WQCB <br /> to rine Date/I']me Date/I'rme Date/I"ime <br /> RELINQUISHED BY <br /> Q RECEIVED BY Special Instruct[otaslComments ContaurerTypes Key <br /> Signature Signature Do Z—: 14 IL-7 11 f Columbia Analytical 40 m]VOA 1 <br /> �] D <br /> 3334 Victor Court 250 ml LPE 2 <br /> Santa Clara,Ca 95054 500 ml LPE 3 <br /> Printed Name Panted Name <br /> 408-748 9700 1 liter HDPE 4 <br /> Firm Firm 500 ml glass 5 <br /> 1liter glass 6 <br /> Dateflime Date/Trme <br /> '2W <br /> ng 7 <br /> g 8 <br /> I <br />