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. CHAIN OF CUSTODY 1 LABORATOY ANALYSIS REQUEST FORM <br /> Pag of,1 <br /> a1433 North Market Boulevard,Sacramento,CA 95834 Service Request No PO Number <br /> aFMCOn (916)928-3300 FAX(916)928-3341 Lab Columbia Anal cal <br /> Project Name Teichert-Stockton , Anal sts Requested <br /> Project Number 20F90-002.007,Task 001 <br /> Project Manager Matt Turner 12 <br /> Company EMCON-Pinnacle 0 w <br /> Address 3939 Cambridge Road,Suite 202 <br /> Cameron Park,C 682 <br /> Phone (530)676-6881 c <br /> FAX (530)676-6885 T4 7� <br /> Sampler's Signature x <br /> z REMARKS <br /> Sample LAB Sample 1 container Tye <br /> I D Pate Time ID Matnx HCl Preservations <br /> AS-1 C S'Y I t q water 3 3 <br /> MW-14 j Z+ water 3 3 <br /> RE ED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Si tt*O <br /> Signature Signature Signature 24hs whr sd.y 11 Report(includes DUP,MS <br /> X semdud(-M]Sww"drys) MSD,as required,may be <br /> Print Printed Name Printed Name Printed Name rsonde VoW tkettm�Rmth charged as samples) <br /> ftwide FAX ft&=wy Ruta III Data Validation Report <br /> Firm Fum Firm Requested Report Due- (includes All Raw Data) <br /> RwQCB <br /> Datw Tune 49 Date/Tune DaterTune DatelI mit (MDIs/PQ1j/TRACEtt) <br /> RELINQUISHED BY RECEIVED BY Special Instractions/Comments Container Types Key <br /> 40 m1 VOA i <br /> SiguUurt Signature Columbia Analytical 250 ml LPE 2 <br /> 3334 Vidor Court SOD mi LPE 3 <br /> Printed Mame Printed Name �� !� � Santa Clara,Ca I liter IiDPE 4 <br /> 408-748-9700 500 int glass 5 <br /> Firm Firm ' I liter glass 6 <br /> 2x6 e/a ring 7 <br />