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CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> Pinnacle,3939 Cambridge Road, Suite 220, Cameron Park, CA Service Request No Purchase Order <br /> IM(ofl (530) 676-6884 Fax(530)676-6885 S on d 0 �3 Lab CAS, Santa Clara <br /> Project Name Apache Plastics Analysis Requested <br /> Project Number 22640-100 001 <br /> Project Manager Mark Capps 21 <br /> Company Pinnacle ; W a 9 c, r <br /> Address 3939 Cambridge Road, Suite 220 4 0 <br /> Cameron Park, CA 95682 U Q <br /> Phone (530)676-688414 <br /> FAX (530)676-688500 <br /> V <br /> Sampler's Signature <br /> Z � O � �d 4 REMARKS <br /> Sample LAB Sample Container <br /> I D Date Time I D Matrix Preservative <br /> Soil X h <br /> 132 <br /> D q <br /> 94') �gya 1ti <br /> )707 �- x <br /> I?--I-Cld ') 2.-Z3 817 l3 <br /> RELIN ISHED BY RECEIX=B, RELINQUISHED BY RECEIVED BYTURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> ,,,Signature---;"—/ Sign t Signature Signature 24 Lr 48 hr 5 day II Report{includes DUP,MS <br /> r Y �' '�0-'r t X Sandwd MSD,as required,may be <br /> Printed Name Printed Name _ Printed Name Pricted Name Pr de VuW Pre],mizwy Resuhs charged as samples) <br /> P,,n? .C-)— � Pr de FAX Prebminazy Resifts III Data Validation Report <br /> Firm iuj <br /> Firm Firm R <br /> Requested Report tate. (includes All Raw Data) <br /> 6 RWQCB <br /> Date/Time e.�` Date/Time Date/Time Date/Time (MDLs/PQLs/'IRACE#) <br /> RELINQUISHED BY RECEMD BY Special Instructions/Comments3 I b + Container Types Key <br /> [ hi 1 "R� 40 ml VOA 1 <br /> rPnnted <br /> ure Signature Send Samples to CAS,3443 Victor C1,Santa Clara,CA 95054 250 ml LPE 2 <br /> 500 ml LPE 3 <br /> Name Printed Name I liter HDPE 4 <br /> 500 ml glass 5 <br /> Firm Firm <br /> / f liter glass 6 <br /> Date/Time Date/T,me it �L° �Q1J " ng $ <br />