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L U S."O!)Y ! RATORY ANALYSIS REQUEST' FORM <br /> t433 North Market Boulevard,Sacramento,CA 95534 Service Request No; Purchase Order: ' C ' <br /> IM(On (916)928-3300 FAX(916)928-334YLab: CASSn <br /> Project Name:Teichert&Sons,Stockton , anta Clara co <br /> jProjcctNumber: Analysis Requested -< <br /> ZOF90-002.007 � <br /> IPraject Manager: Matt Turner e <br /> COmpany: Pinnacle oNo z <br /> j ;Address: 3939 Cambridge Road,Suite 220 o o v <br /> Cameron Park,CA 95682 00 CC Q Q Q CA <br /> .Phone: (530)676-6884 w. a <br /> ;FAX: (530)6766885 � .Q � w in <br /> U <br /> 'Sampler's Signature: <br /> 7 H RSample— <br /> REMARKS <br /> F-E—A p e ST BT BT BT REMARKS <br /> Types <br /> I.D. Date im <br /> 7;7 <br /> e I.D. Matrix hP NP NF NP <br /> Preservations <br /> SP 1.A/B 3;23199 ,2 sail 2 X X X X <br /> SP•2.AB 3.23199 soil Z X X X X eft <br /> SP-3 AID 3./13'99 soil 2 X X X X <br /> SP-4 AB 32;/99 soil 2 X X X X -' <br /> —-- r J.' "` SOJ X X X o <br /> SP-6 AB 3124!99 <br /> I snit 2 X X X X N <br /> SP-7 AS 3124199 }3 I soil 2 X X X }( af <br /> 5P-8 AB 324'99l - <br /> 1 ( soil 1 2 X Ix X X <br /> SP-9 A.11B 3124;99 soil 2 X X X X <br /> SP-10 A;B 3124199 soil 2 X X X X <br /> n <br /> SP-!IA,rB 324199 soil 2 X X X X o <br /> SP-I2 A83124199 7 <br /> ;Q� 2 x x x xREL <br /> QU1S Y � RE[LT+IQU1 UM BY ttECEV%rM BY TURNAROUN <br /> t2EP TttF.Q[IlRentev-rs <br /> gnature , [.IRE1'LER'1'S <br /> X !. Routine Rtpan <br /> (�}}'�� Signature si natwe <br /> Harold DUkt ply MA-(�I' 1'� - a 2s hr -4i hr �' S dy If. RCpOTL OnC(U&S DUP.MS <br /> �l sr�aAa f-la>>tic�a�e:�:J MSD,as crquircA may be p <br /> Printed Name Printed Name Printed Name Primed Name IRovidc veftW e.eliminmy Rawtts i <br /> BICON (/f�Cr charged as samples) <br /> Firm Fi Fum )f ideFAXPnimniry'Aemla III Data Validation Repan <br /> •� 3- 4Ud Firm x d�fWC (includes All Raw Data) <br /> I) " ri a DaluTirne _ --.- AwQcu <br /> RELJLNQUISHED BY RECEWED BYSpecialD f (MDLVPQLsffRACE*) <br /> Tastructioos/Caimwen#s: ConFainerTV,_s Key_Lt .cam <br /> _ mi VOA I <br /> CD <br /> Signature Si�rarure 1) For arygenates,analy=for?-M1r, 40TBA,O1PE,ETRE,and TAME <br /> usin aMO 250 mJ J.PE: OD.P <br /> g <br /> Printed P7sme Printed Name 500 ml LPE: 3 to� �� � <br /> CoTnposirc AIB samples i>7 lab for ONE ar:atysI I i ter HDPE. 4 <br /> is o <br /> Firm Fir 500 ml glass: 5 <br /> 1]iter glass. 6 <br /> Date?imc path-Ime 2x6 SA:ing i <br /> glass jar g 's' <br /> I <br />