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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br /> o 1433 North Market Boulevard, Sacramento,CA 95834 Service Request No: Purchase Order: <br />•r <br />?t EMCOII (916)928-3300 FAX(916)928-3341 -5 ctiq pQ f1l 7 Lab'. CA 5 <br /> 00 Project Name:Teiehert&Sous,Stockton Anahsis Requested <br /> 00 Project Number. 20F90-M.007 <br /> Project Manager: Matt Turner <br /> O7 Company: Pinnacle <br /> G v p <br /> o Address: 3939 Cambridge Road,Suite 220Zn <br /> •� c a <br /> N <br /> Cameron Park, CA 95682 < < < N <br /> Phone (530)676-6884 w u u°.. 0. N <br /> FAX: (530)676-" n ' ° jGna <br /> �Samplzr'sSignatue: j� $ d d >i <br /> t c _ m <br /> zF- p O F REMARKS <br /> amp a mP a Container Types <br /> 04 <br /> I.D. A312333/99 <br /> Time I.D. Matrix =___ Preservations <br /> TK-8E 4 soil 1' X X X X <br /> zo TK-8C 15:25 soil I X X X X <br /> TK-8W 1530 soil 3 X X X X <br /> LU DS-1 (3.5� 324!99 9:5{) soil I X X X X <br /> DS-2(3.5) 3/24!99 9:45 soil l X X X J X <br /> a PL-1 (3.5') 324'99 9:55 soil 1 I X X X X <br /> r <br /> 0 <br /> m <br /> m <br /> N <br /> N RE Q Y kEIVE RELPVQLTSHED BY' RECEI\'ED RY' Tt'RV.4ROUND REPORT REQLIIRENIENTS <br /> G} REQUIREMENTSX I. Routine Report <br /> Srptanue 5ign�r a sipatum I • i„ ae r. s d,; B. Report(includes DUP,AIS <br /> idarotd Duke 1ALk114asMSD,asrequired,maybe <br /> Primed Name Printed Name Printed Name =,,.:,r�deri Rdiaiury a-,:trc charged as samples) <br /> EMCON m4f. snicnmman aur.. Ili.Data Validation Report <br /> F' <br /> P%' a�q n� Finn Firm aaq�.aan�nnre. (includes All Raw Dva) <br /> f RWQCB <br /> ate/rime DMcq iihe DadeTmw: DadetTime (MDLslPQLsfFRACEA) <br /> RELLNQUISREDBY RECEIVED BY Special loetruulans/Comments: t� (/ q Comaiw Types Key: <br /> 7 ` f -1� ` a 1 � 40 ml VOA: 1 <br /> Signature Signature 1) For oxygenates,analyze for MTBE.TBA.DIPE.ErBE.and TAME 250 m)LPE- 2 <br /> L+? "Sing 82% 500 ml LPE: 3 <br /> Printed Name Printed Name 2) If total lead by X74/20 is ereater than 50 ppm.then analyze for total lead bF 7421 1 liver FiDPE. 4 <br /> 7 Firm FM )) pp..�� `�a'� TL,,rru r v r LJ - TAT5130ml glass, 3 <br /> � ` }r• J I liter glass' 6 <br /> Dat0 imz D�?� f 2x6 s/s rine: 7 <br />