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0 CHAIN OF CUSTODY / LABOROORY ANALYSIS REQUEST FORM 0 ~ <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order 1 Z`76 7-8 a�j� <br /> (916)928-3300 FAX(916)928-3341 Lab SEQUOIA <br /> Project Name Don Rogers Analysts Requested <br /> Project Number 1T#792773/22613-100 003 <br /> Project Manager Mark Capps o <br /> Company 1T 1 EMCON � <br /> Address 3939 Cambridge Road,Suite 220 173 2 <br /> cc <br /> c o <br /> Cameron Park,CA 95682 Q <br /> Phone (530)676-6881 U X <br /> O o <br /> FAX (530)676-6885 I H Cq <br /> o <br /> Sampler's Signature <br /> - x <br /> m <br /> 2 F- 2 . <br /> REMARKS <br /> Sample LAB amp e '�r I Container Types <br /> I D Date Time I D Matrix 7' HCl Preservations <br /> MW-1R water 3 3 <br /> RELINQUISHED.13Y f, RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> �t f�1' REQUIREMEN IS X 1 Routine Report <br /> Sign ure Signatrer Signature Signature 24 hr 48 hr 5 day 11 Report(includes DUP,MS <br /> Standard—(-10.I5 workm6 days) MSD,as required,may be <br /> Printed Name P mtF ame Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> V" C - ct �rS Provide FAX Preliminary Results Ill Data Validation Report <br /> i firm Firm RequLsied Ripon DaIL (includes All Raw Data) <br /> I <br /> i`t 146 �� Q�+� F .0 f q RWQCB <br /> Date/Time Datefrn a bate/Time Date/Time (MDLs/PQLs/7RACE#) <br /> RELINQUISHED BY RFM,1VVn hy Special Insti ucttonslComments Sequoia Anal tical Container Types Key <br /> 819 Striker Ave,Ste 8 40 ml VOA 1 i <br /> Signature Signature Sacramento,Ca 9A34 125 ml LPE 2 <br /> 916 921-9600 500 ml LPE 3 <br /> Printed Name Printed Name Contact Rob Babel 1 liter HDPE 4 <br /> 500 nil glass 5 <br /> Firm Firm f liter glass 6 <br /> 2x6 s/s ring 7 <br /> Datefrime Date/Time glassjar 8 <br />