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0 CHAIN OF CUSTODY 1 LABORA&Y ANALYSIS REQUEST FORM 9 - <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No PO Number NIA Page 1 of 1 <br /> rincon (916)928-3300 FAX(916)928-3341 Lab CAS <br /> Project Name Teichert-Stockton Anal sts Requested <br /> Project Number OF90-002 004,Task 001 <br /> Project Manager Matt Turner <br /> Company EMCON c <br /> Address 1433 North Market Boulevard <br /> Sacramento,CA 95834 U <br /> Phone (916)928-3300 0 <br /> FAX (916)928-334 w <br /> Sampler's Signature — S <br /> z REMARKS <br /> Sample LABEvaor <br /> S Contamer Types <br /> ID Date Time ID NP Preservatinns <br /> Influent i{4S -Z� 1 1 <br /> Effluent IZ�'(�� is 1 1 <br /> RELINQUISHED BYR#EIVED BYELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> L REQUIREMENTS X I Routine Report <br /> Signature ignature Signature Signature 2411F 4ebr Sar II Report(includes DUP,MS <br /> C rrteYit-si r� at IV X &aadvd(-tal5w�my%) MSD,as required,may be <br /> Pruned Name PantedV.-;� Printed Name Printed Name PMVI&ve"htLm=y Rcmhs charged as samples) <br /> i <br /> '0-111LIW Pr*vWe FAX Pxkm wy Rcs&s III Data Valtdauon Report <br /> FirmFinn Finn Fum Requaied Report Dam (includes All Raw Data) <br /> q 4 1?5 0 7z RwQCB <br /> Daterrime Datelrime Date rime Daterrrme (MDLA'QLs/rRACE#) <br /> RELINQUISHED BY RECEIVED BY Spectal Insirucdonscmam nts Container Types Key <br /> 40 nil VOA I <br /> Signature Signature Pieria repurl results In Wh ppmv and mghii' I25 nil LPE 2 <br /> W)itil I Ph 3 <br /> Printed Name Printed Name I liter IIDPE 4 j <br /> 500 nil glass 5 <br /> Firm F7n I liter glass 6 <br /> 2x6 s!s ring 7 <br /> In 1inrr'nnr 11�tr/T9tnr 1 in r T<<1t r h i� A <br />