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CHAIN OF CUSTODY 1 LABORATA ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Risk M rit sx(803134-7475) <br /> Service Request No Purchase Order g <br /> q Lab SEQUOIA <br /> It con (916)928-3300 FAX(916)928-3341 Anal sts Re uested <br /> Project Name Don Rogers <br /> Project Number 22613-100 001dd <br /> oProject Manager Deanna Santos 9a 00 <br /> Company EMCON-Pinnacle <br /> Address 1433 North Market Boulevard 0 <br /> 0 00 <br /> Sacramento,CA 95834 U 0g 3 <br /> Phone (916)928-3300 0 0O <br /> FAX (916)928-3341 T 05 <br /> Sampler's Signature z Ou a REMARKS <br /> Container Types <br /> n I <br /> Sample LAB SampIt; Preservations <br /> I D Date Time I D Matrix Hcl HCI <br /> MWAR i rl�t' i' water 5 3 <br /> 2 <br /> RECEIVED 8Y TURNAROUND REPORT REQUIREMENTS <br /> U Y RECEIVED BY RELINQUISHED BY REQUIREMENTS X I Routine Report <br /> Signature Signature 24 to 48 hr 5 day Il Report(includes DUP, <br /> St urq I� Signature Sw lord(-ILL t5 woriin=days) MSD,as requined,may be <br /> t t.l Printed Name PnM&Verbai Praiminary Rrsatu charged as samples) <br /> NamPrin Nae Printed Name Printed Name <br /> Yrarrdc FAX Prelrmmary Resulu 111 Data Validation Report <br /> Firm �gaesW Repan Dae (includes All Raw Data) <br /> Q Firm Firm inn RWQCe <br /> � �-LT Y (MDL.s1PQLs/TRACE#) <br /> M 3 <br /> SDaiell"iine Date/Time Datellime <br /> DatelTime Sequoia Analytical Container Types Key <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments, 8t9 Striker Ave Ste 8 40 ml VOA i <br /> Sacramento,Ca 95834 125 ml LPE 2 <br /> S n 916-921-9600 500 mi LPE 3 <br /> Signature <br /> Contact Rob Babel 1 atter HDPE 4 <br /> Printed Name pnritegt4aing 500 ml glass 5 <br /> 1 Iliterglass 6 <br /> Finn I t C ' r 2x6 s/s ring 7 <br /> b `{ glassjar S <br /> Date/Tlme Dat une <br />