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CHAIN OF CUSTODY / LAB.ATOR'Y ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: Purchase Order: n <br /> m <br /> >:fllcon (916)928-3300 FAX(916)928-3341 Lab: CAS, Santa Clara <br /> lProject Name: Teichert& Sons,Stockton Analysis Requested <br /> l Project Number: 20F90-002.007 <br /> Project Manager: Matt Turner <br /> rq <br /> ;Company: Pinnacle <br /> (Address: 3939 Cambridge Road,Suite 220 G o o oo co � W <br /> Cameron Park,CA 95682 0 a �D <br /> Phone: (530)676-6884 4. <br /> FAX: (530)676-6885 a ] a <br /> Sampler's Signature: x x w <br /> 2 H H M O 1 1 1 1 1 1 1 1 REMARKS <br /> Sample LAS Sample BT BT BT BT Container Types <br /> I.D. Date Time I.D. Matrix NP NP NP NP Preservations <br /> SP-1 AB 3123/99 soil 2 X X X X <br /> SP-2 AIB 3123199 soil 2 X X X X <br /> SP-3 A/B 3/23/99 sail 2 X X X X <br /> SP-4 A/B 3/23/99 soil 2 X X X X <br /> SP-5 A/B 3/23/99 soil 2 X X X X <br /> SP-6 AIB 3/24/99 soil 2 X X X X <br /> SP-7 AIB 3124199 soil 2 X X X X <br /> SP-8 A/B 3/24/99 soil 2 X X X X <br /> SP-9 A/B 3124199 soil 2 X X X X <br /> SP-10 AB 3/24199 soil 2 X X X X <br /> REL QUIS JatuEk <br /> IV D BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> C, C 4) REQUIREMENTS X 1. Routine Report <br /> gnature Signature Signature 24 hr 4a hr 5 day II. Report(includes DUP,MS <br /> Harold Duke P }(l4-tff t-cam X Standard(-10-15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Resu4s charged as samples) <br /> EMCON CI Provide FAX Preliminary Resuiis 111.Data Validation Report <br /> �} Fi Firm Firm Requested Report Date (includes All Raw Data) <br /> "LA Ci 0-4 RwQCB <br /> Date/Tim IlDak/Tillne Date/Time Datefrime (MDLs/PQLs,/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> 40 ml VOA: l <br /> Signature Signature 1) For oxygenates,analyze for MTBE,TBA,DIPS,ETRE,and TAME 250 ml LPE: 2 <br /> using 8260 500 ml LPE: 3 <br /> Printed Name Printed Name l liter HDPE: 4 <br /> Composite AIB samples in lab for ONE analysis 500 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> DatefFime Date/Time glass jar: 8 <br />