Laserfiche WebLink
CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of— <br /> IT/EMCON - 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: 1T P.O. No: 135497 OP <br /> (916)928-3300 FAX(916)928-3341 Lab: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: IT#791289 <br /> Project Manager: Steve Giacomini ;o <br /> Company: IT/ EMCON <br /> Address: 1433 North Market Boulevar N v <br /> Sacramento CA 95 34 0 00 <br /> Phone: (916)928-3300 w a $° <br /> FAX: (916)928-3341 z <br /> Sampler's Signature: O <br /> z � � <br /> REMARKS <br /> Sample LAB Sample a � 1 4 <br /> TimeContniner'I'yPcs <br /> I.D• DeIC Time I.D. Matrix 1��,;;_ IICI NP Preservationsater <br /> MW-3 water 4 3 l <br /> Field Blank water 3 3 <br /> RE N 1 BY R rCEIVED BYRELINQUISIIED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> na�ca - REQUIREMENTS X I. Routine Report <br /> Sign ( Si alure Signature Signature 24 hr 48 l 5day II. Report(includes DUP,MS <br /> I LftafmX standard(—to-t5 working days) MSD,as required,may be <br /> Printed Natuy 1'r'ntcd Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> na-I Provide FAX Preliminary Results 111.Data Validation Report <br /> Finn Firm Firm <br /> � �� l(7 Firm Requested ReponDate: (includes All l2awData) <br /> U01 <br /> X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDtslPQls/TRACEk) <br /> REI,INQUISIIED BY RE'C'EIVED BY Special Instructions/Conrments: Container Types Key: <br /> Sequoia Analytical 40 nil VOA: I <br /> Signature Signature Please report MDLs,PQLs and Trace. 819 Striker Avenue,Ste.8 250 nil LPL: 2 <br /> Nitrate-Nitrogen has a 48-hr hold(line. Sacramento,Ca 95834 500 nil LPL': 3 <br /> Printed Nantc Printed Name <br /> 916-921-9600 1 liter IIDI'E: 4 <br /> Firm Pinu 500 nil glass: 5 <br /> liter glass: 6 <br /> 2x6 s!s ring: 7 <br /> Dato/"I'iune Datell'ime <br /> glasslar <br />