Laserfiche WebLink
CHAIN OF CUSTODY 1 LABORA*RY ANALYSIS REQUEST FORM . <br /> 01433 North Market Boulevard Sacramento,CA 95834 Service Request No: Purchase Order: <br /> >r O (916)928-3300 FAX(916)928-3341 Lab: Sierra Analytical <br /> Project Name: USA Gasoline Station#65,Lodi,Ca Analysis Requested <br /> Project Number: 20A41-008.001 <br /> Project Manager: Gowri Kowtha LQ <br /> c 0 <br /> Company: EMCON-Pinnacle r� v <br /> Address: 144 "A" Mayhew Way '� o <br /> Walnut Creek,Ca 94596 U XrA <br /> .; d <br /> Phone: (925)977-9023 a <br /> FAX: (925)977-9030 <br /> Sampler's Signature: _ x N <br /> z o c REMARKS <br /> amp a Sample IContainerTypes <br /> I.D. Date Time I.D. Matrix HCl Preservations <br /> MW-1 16 12 1-7 water 3 3 <br /> MW-2 j ") water 33 <br /> MW-3' water 3 3 <br /> MW-4 IL( 2 water 3 3 <br /> MW-5 1 55� water 3 3 <br /> MW-6 1L{ water 3 3 <br /> MW-7 water 3 3 <br /> MW-8 j '� water 1 3 3 <br /> S-1 !2 water 3 3 <br /> S-2 water 3 3 <br /> RELLNQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Slure r!/ Signature Signature Signature 24l 48 hr X w day 11. Report(includes DUP,MS <br /> Sta�ufaull—ia-IS working days) MSD,as required,may he <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Pmlunirwry Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Finn Reqnesled Report Data: (includes All Raw Data) <br /> RWQCB <br /> [] tef 1 e Daterrime Dalerrime DaterTimc7771 <br /> (MDLc/PQLsrTRACE9) <br /> RELINQUISHED BY RECEIVED BY Special Instruetions/Conunents: Container Types key: <br /> Slerra Labs 40 ml VOA: I <br /> Signature Signature 26452 Merit Circle,Ste.105 250 ml LPE: 2 <br /> Defection Urnits fur MTBE by 8260 need to Laguna Hills,Ca 92653 500 ml LPE: 3 <br /> Printed Name Printed Name be 0.5 ppb. 949-348-9389 1 lifer HDPE: 4 <br /> Detection Limits for TBA must be 5ppb. Rick Forsythe 500 ml glass: 5 <br /> Firer Firm 1 liter glass: 6 <br /> 2x6 sk ring: 7 <br /> Daterrime Daterrime <br />