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, �r ■r rr �r rr �r ar rr ■r rr rr rr rr rr r rr <br /> CHAIN OF CUSTODY <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA95834 <br /> ABORAT ANALYSISrr REQUEST FORM <br /> Service Request No: Purchase Order: Direct Bill USA <br /> (9167 928-3300 FAX 916)928-3341 <br /> Project Name: USA Gasoline Station#65,Lodi,Ca Lab: Sierra Analytical <br /> Project Number: IT# 7920651 20A41-005.001 Anal sis R nested <br /> Project Manager: Dave Foley o c <br /> w O <br /> Company: IT I EMCON <br /> Address: 1433 North Market Boulevard <br /> Sacramento,Ca 95834 v X U <br /> Phone: (916) 928-3300 C. <br /> FAX: (925)928-3341 A 3 <br /> Samplers Signature: <br /> N <br /> z O <br /> i 5arnple LAB Sample I REMARKS <br /> I.D. Date Time I.D. MatrixNCl Container Types <br /> 1 ( Preservations <br /> water 3 3 <br /> MW- `� 1ST ,. <br /> MW-2 Z 2 water 3 3 <br /> MW-3 q Z water 3 3 <br /> MW-4 water 3 3 <br /> MW-5 (7110 i water 3 3 <br /> MW-6 (U water , 3 3 <br /> MW-7 `['Z water 3 3 <br /> MW-8 �2 water 3 3 <br /> S-1 water 3 3 <br /> S-2 water 3 3 <br /> RELINQUISHE Y RECEIVED BY RELINQUISHED BY RECEIVED BY l' TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Sig ure �J Signature Signature Signature 24 to 4e to X 10 day It. Report(includes DUP,MS <br /> Printed Name p Name stand+rd(-to.l s woddng days) MSD,as required,may he <br /> l Printed Name Printed Name P—de VQW Prdm wy Results charged as samples) <br /> Finn�} Firm Finn FiProoedeFAX PnknauryRestdts III.Data Validation Report <br /> 1 .3 W �J � � Firm Requested Report Date. (includes All Raw Data) <br /> Date/Time Datw TimeR WQCB <br /> Dateme Datell irne LsrTRACE#) <br /> RELINQUISHED By RECEIVED BY Special alInstructions/Comments: (MDLa1PQ <br /> Container Types Key: <br /> Signature Signature Sierra Labs 40 ml VOA: I <br /> 16052 Merit Circle,Ste 105 250 ml LPE: 2 <br /> Detection Whits for MTBE by 8260 need to <br /> Printed Name Laguna Hills,Ca 92653 500 ml LPE: 3 <br /> Ill Printed Name be 0.5 ppb. <br /> 949,348-9399 I liter HDPE: 4 <br /> Defection Limits for TBA must be 5ppb. Rick Forsythe 500 ml glass: 5 <br /> Firm Firm <br /> Golden State# 14365 1 liter glass: 6 <br /> DateJTimeDatelTime 2x6 s/s ring: 7 <br />