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c.HAIN OF CUSTODY/ LABOVORY ANALYSIS REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 <br /> 0 <br /> smton (916) 928-3300 FAX(916)928-3341 Service Request No Purchase Order Risk Mngt PO4 S4333-0 <br /> Project Name IBC-Stockton - - - Lab SEQUOIA <br /> Project Number 22605-101 003 Analysts Requested <br /> Project Manager Mark Capps <br /> -PT iF-7- <br /> Company EMCON-Pinnacle o <br /> N <br /> Address 3939 Cambridge Road,Suite 220 <br /> INS <br /> Cameron Park, CA 9682 <br /> C:) <br /> Phone (530)676-6881 6 <br /> FAX 0 U � � <br /> (530)676-6885 a <br /> Sampler's Signature <br /> C7 <br /> a� <br /> amp e z t-0.'- 2 <br /> I D amp Fe— <br /> I REMARKS <br /> Date Time ID Matrix 11C1 Container Types <br /> MW-1 JA*5 !lit Preservations <br /> water 3 <br /> MW-2 /!39' �1 3 <br /> water <br /> RELINQ D BY RECE VED BY <br /> RELINQUISHED BY RECEIVED BY <br /> TURNAROUNDE REPORT R QUIREIHEN'1S <br /> gnaturc ig ture REQUIREMENTS <br /> Signature 5rgnature X 1 Routine Report <br /> a 24 hr 42 hr 5 day If Report(includes DUP,MS <br /> r anted Name Printed Name Standard(-x0.15 workingdays) MSD,as required,may be <br /> Printed Name Printed Nan e <br /> Provide Vabar Preliminary Results charged as samples) <br /> Finn F1rm + Provide FAX Prdimmaty Results III Data Validation Report <br /> Firm 1-irm <br /> Requested RrportDate (includes All Raw Data) <br /> Dale rime Dale/rrmeI3 <br /> RELINQUISHED BY UatelfRWQC <br /> lme Date/Ti me <br /> RECEIVED BY Specrai Instrucirons/Comments (MDI s/PQ1 stFRACE#) <br /> Signature Container Types Key <br /> Signature Sequoia Analytical 40 ml VOA t <br /> 819 Stryker Ave,Ste 8 <br /> Printed Name 250 ml LPE 2 <br /> Printed Name Sacto,Ca 95834 500 ml LPE 3 <br /> 916-921-9600 1 liter HDPE 4 <br /> Finn t ifRl Attn Ron Bobel 500 ml glass 5 <br /> Date/rime Dare��lme I liter glass 6 <br /> 2x6 sls ring 7 <br /> glass�ar 8 <br />