Laserfiche WebLink
GAIN OF CUSTODY 1 LABOOTORY ANALYSES REQUEST FORM <br /> i <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No Put chase Order Z of Q s <br /> (916)928-3300 FAX(916)928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Analysis Requested <br /> Project Number IT#792759/22605-101003 <br /> Project Manager Mark Capps <br /> Company IT/EMCON v <br /> Address 3939 Cambridge Road,Suite 220 <br /> 0 <br /> Cameron Park,CA 9682 <br /> Phone (530)676-6881 >C o <br /> FAX (530)676-6885 <br /> Sampler's Signature <br /> zREMARKS <br /> Sample 1 LAB Sample - 1 Container Types <br /> ID Date Time ID Matrix NCl Preservations <br /> MW-1 j it ho water L3 3 <br /> MW-2 lip water 3 3 <br /> RELINQUISHRECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREl11ENTS <br /> REQUIRE1%IL'NrS X I Routine Report <br /> 24 hr 48 hr 5 day 11 Report(mcludes DUP,MS <br /> S a re SignaiurE Signature Signature �{ Standard(—IQ 15 war►ingdaysi MSD,as required may be <br /> Printed Mame P ntrd Name Printed Name Printed Name Provide Verbal PrLimunary Resulu charged li samples) <br /> L �1� \5� e 11l Data Validation Report <br /> Provide FAX Preliminary Rewlia <br /> FI IT) ,YFIrni 5e Firm firm Reyuesied Report pare (includes Ali Raw Data} <br /> 11 1/44 CY[ � G 1 RWQC13 <br /> Datelrlme Daterrime Daterrime Date/rime (MDLs/pQ Container Types <br /> } <br /> rr <br /> REI INQUISHED BY RE EIS ED BY Special InstruCtlons/Comments pes Key <br /> Sequoia Aualytlt,aE 40 int VOA l <br /> Signature Signature 819 Sinkcs AVL,Sic. 8 250 ml LPE 2 <br /> Sacto,Ca 95834 500 ml L PE 3 <br /> Printed Name Printed Name 916-921-9600 1 liter IADPE 4 <br /> Attn Ron Sobel Soo ml glass S A <br /> I liter glass 6 <br /> Firm Firm <br /> 2x6 sls ring T <br /> Date/rime Daterrime glassjar 8 <br />