Laserfiche WebLink
CHAIN OF CUSTODY lLABORA&Y ANALYSIS REQUEST FORM <br /> eQ <br /> P1433 North Market Boulevard,Sacramento,CA 95834 Service Request No Purchase Order - <br /> Emcon (916) 928-3300 FAX (916)928-3341 Lab SEQUOIA <br /> Project Name IBC-Stockton Anal s1s Requested <br /> Project Number 22605-101003 <br /> Project Manager Mark Capps —o <br /> C) 5 <br /> Company EMCON-Pinnacle 9 <br /> kn v <br /> Address 3939 Cambridge Road,Suite 202 0 2 <br /> Cameron Park,CA 9682 25 <br /> o <br /> Phone (530)676-6881 0 o N00 <br /> FAX (530)676-6885 .. <br /> Sampler's Signature W <br /> z I I IREMARKS <br /> Sample LAB Sample I lContamerTypes <br /> I D Date Time I D Matrix 91 HCI HCI Preservations <br /> MW-I -?f^qI 1209 water 5 3 2 <br /> MW-2 water 5 3 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> sl&rtatyre Signature Signature Signature 24 hr 48 t: 5 day Il Report(includes DUP,MS <br /> stUmstd f-tats wrlcnj days) MSD,as required,maybe <br /> ed Name Printed Name Printed Name Printed Name Pmvi&VerbA Ptnlmmuy Resulu charged as samples} <br /> t } <br /> Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Aum Firm Requested Report Date (includes All Raw Data) <br /> cormd RWQCB <br /> Date/Fume Date/rune Date/fime Date/I"tme (MDLslPQL,FRACE#) <br /> RELINQUISHED BY y, RECEIVED BY Special Instructlons/Comments Container Types Key <br /> Sequoia Analytical 40m]VOA I <br /> Signature 819 Stnker Ave,Ste 8 250 ml LPE 2 <br /> ` Sacto,Ca 95834 500 ml LPE 3 <br /> Pnrttrd Name Pn a 916-92t-9600 1 liter HDPE 4 <br /> 500 ml glass 5 <br /> Finn Ft 1 Inter glass 6 <br /> 2x6 sls ring 7 <br /> Datemme Date tine glasslar 8 <br />