Laserfiche WebLink
_ Y <br /> CHAIN OF CUSTODY /LABORA ANALYSIS REQUEST FORM <br /> � q <br /> IT 1 EMCON - 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: <br /> Purchase Order: <br /> Lab: Sierra Anal tical <br /> (916)928-3300 FAX (916)928.3341 Anal sis Re uested <br /> Project Name:USA Gasoline Station#65,Lodi,Ca �. <br /> Project Number: IT#792065/20A41-008.001 -- F � <br /> Project Manager: Dave Foley 'Q <br /> Tor <br /> Company: IT/EMCON u t' <br /> Address: 1433 North Market Boulevard c 3 <br /> 0 <br /> Sacramento,Ca 95834 U w U p <br /> Phone: (916)928-3300 p <br /> 0 <br /> FAX: (925)928-3341 bmbE o�u <br /> Sampler's Signature: — z x " E REMARKS H O <br /> Container Types <br /> Sample LAB Sample I <br /> Preservations <br /> I.D. Date Time I.D. Matrix <br /> MW-I 1214 1311 V water 3 3 <br /> MW-2 '� !3115 water 3 3 <br /> MW-3 <br /> { !311 water 3 3 <br /> MW-4 [ /&11-7 water 3 3 <br /> MW-5 `�OCr +3 1!fr water 3 3 <br /> MW-6 l 2 r3 !! water 3 3 <br /> MW-7 c{t{Z 1312.6 water 3 3 <br /> MW-8 /31 LI water 3 3 <br /> S-I !3►LZ water 3 3 <br /> 11 $ <br /> S-2 Q 1317-31 water 3 3 <br /> RE�QUISH B RECEIVED BY <br /> RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> a �� SG��+` REQUIREMENTS X I. Routine Report <br /> Si nature S Signature Signature i4 to 4x hr X Wday U. Report(include, DUP.MS <br /> Si tore MSD,as required,may be <br /> l.,l•-e�n SI:�nJud(-IU-IS working days] 9 y <br /> JU <br /> Printed Name <br /> 1 Printed Name Printed Name Printed Name Provide Verbal Preliminar)Resuh charged as samples) <br /> ��Gdd� ��� PmvjJeFAX Preliminary Results ill.Data Validation Report <br /> -Co-', Firm Requested Reror:o:,le: (includes All Raw Data) <br /> Firm Firm Firm <br /> RWQC13 <br /> 12 0 CIS (� bobw( /Z A IZ 4 i io;v 0 (MDLs/PQLsaRACE#) <br /> Dat tme Date/Time Datc/Time lDateflimc <br /> Container Types Key: <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Sierra Labs 40 ml VOA: I <br /> 26052 Merit Circle,Ste.105 250 ml LPE: 2 <br /> Signature SignatureLaguna Hills,Ca 92653 500 ml LPE: 3 <br /> Detection limits for MTBE by 8260 need to <br /> 949-348-9389 l liter HDPE: 4 <br /> Printed Name be 0.5 ppb. Rick Forsythe 500 m]glass: 5 <br /> Printed Name <br /> � Detection Limits for TBA must be Sppb. 1 liter 6 <br /> Golden State# 14365 8 <br /> Firm Firth 2x6 s!s ring: 7 <br /> patelrime Date/rime <br />