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663 <br /> CHAIN OF CUSTODY / LABORAY ANALYSIS REQUEST FORM Pag ofNorth Market Boulevard,Sacramento,CA 95834 11Wvice Request No PO Number NIA 1W <br /> F1 con (916)928-3300 FAX(916)928-3341 Lab CAS <br /> Project Name Teichert-Stockton Anal sls Re uested <br /> Project Number 20F90-002.004,Task 001 <br /> Project Manager Matt Turner <br /> Company EMCON-Pinnacle <br /> Address 3939 Cambridge Road,Suite 202 <br /> Cameron Park,CA 95682 U <br /> Phone (530)676-6881 0 <br /> FAX (530)676-6885 <br /> Sampler's Signature <br /> x <br /> zI IREMARKS <br /> ampl LAB Sample 1 Container Types <br /> I D Date Time ID Matrix HCI Preservations <br /> MW-9 water 2 2 <br /> MW-10 Sa water 2 2 <br /> MW-11 153$' water 2 2 <br /> water <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signature Si re Signature Signature 24 hr 48 hr s day II Report(includes DUP,MS <br /> -y-standard(-10.15 wof"days) MSD,as required,may be <br /> ool <br /> t e Printed Name { Punted Name Punted Name Prmide verbal Prehmmaty Results charged as samples) <br /> ` t Cit A Prmde FAX Preh mmary Results III Data Validation Report <br /> Firm Firm Firm Finn Requested Report Date (includes All Raw Data) <br /> 0*Atm I I Q. `S RWQCB <br /> Date/Time Pat-Tirne 46 .W Tem, Date/Time <br /> PMDl..s/PQLsJ7RACEfi) <br /> RELINQIJISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature Columbia Analytical 250 ml LPE 2 <br /> 3334 Victor Court 500 m1 LPE 3 <br /> Printed Name Printed Name Santa Clara,Ca I tiler HDPE 4 <br /> 408-748-9700 500 ml glass 5 <br /> Firm Firm 1 liter glass 6 <br /> 2x6 sls ring 7 <br /> Date/1'eme Date/Trrne gkass�ar 8 <br />