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CHAIN OF CUSTODY 1 LABORATRY ANALYSIS REQUEST FORM 0 - <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No PO Number NIA Page 1 of 1 <br /> rEmcon (916)928-3300 FAX (916)928-3341 _ r <br /> �_. Lab CAS <br /> Project Name Teicherl-Stockton Anal sis Requested <br /> Project Number OF90-002 004,Task 001 <br /> Project Manager Matt Turner <br /> Company EMCON <br /> Address 1433 North Market Boulevard <br /> Sacramento,CA 95834 ° <br /> U <br /> Phone (916)928-3300 c <br /> FAX (916)928-3341 <br /> Sampler's SignatureE x <br /> = � REMARKS <br /> Sample LAB Sample l I lContainerTypes <br /> ID Date Time ID Matrix HCl Preservations <br /> MW-9 lilt3 >' N ID / water 2 2 <br /> MW-10 )5 2 water 2 2 <br /> MW-11 13 3 water 2 2 <br /> i <br /> MW-14 t 10 4- water 2 2 <br /> RLI INQUISHED BY RINEIVED BY Rl INQUISHED BY RECFIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signature Vriature Signature Signature 24 hr 48 Ur s day 11 Repun(indudes DUP NIS <br /> , z,tf,r'", '—r !( X Sundard(-10-15-orLmgdays) MSD,as required maybe <br /> Pnnled Name PnmLd Na � PnniM Natnc Pnnud Name Pm c VCAW hrimanery Rno1i. Liiargrd ati+ampleO <br /> Jj Pnivide I AX Prthnunary Rnu11. III Data Validation Relwrt <br /> uw l inti I wii 1 wn XaIw.tcd Rr1.m Rdc (Indukks All Raw pals) <br /> 54D RWQCB <br /> D.'iterrime Datel ime "ine Dale/ ime (MDLs/PQLsrMACE11) <br /> RFI INQUISHED BY RECEIVED BY Special InslructionslComments Container Types Key <br /> 40 in]VOA 1 <br /> Signature Signature 125 ml LPE 2 <br /> 500 ml LPE 3 <br /> Printed Name Printed Name 1 Iver IIDPE 4 <br /> 500 ml glass 5 <br /> firm Furs 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> DaIdTime - Daleflime - _ _ - —_—�_ Tplass jar 0 <br />