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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of- <br /> 1T/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: IT P.O. No: 135497 OP <br /> (1916)928-3300 FAX 916)928-3341 Lab: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: IT#791289 ,n <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevard N rn <br /> Sacramento CA 95834 � 00 <br /> o <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 + U <br /> Sampler's Signature: �j <br /> O yti I <br /> I I IREMARKS <br /> Sample LAB amp e 1 4 Container Types <br /> 1.D. D to Time I.D. Matrix HCl. NP Preservations <br /> MW-1 1 0 Na D water 4 3 1 <br /> MW-2 fl water 4 3 1 <br /> MW-3 water 4 3 1 <br /> Field B - water 3 3 <br /> I.1 I 'D BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature 24 hr 49 hr —5day Il. Report(includes DUP,MS <br /> X standard(-10.15 worUig days) MSD,as required,may he <br /> Printed Lwv"', Printed Name Printed Name provide Verbal Prelituiaary Results charged as samples) <br /> Provide FAX PreWrtinaty Results III.Data Validation Report <br /> Firm 1 ir�O 2 f Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> ,O''7iV ,� M3 X RWQCB <br /> Datel Tune DatdTime Date/Time Data/Time (MIX PQl • TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: ContlmerTypes Key: <br /> Sequoia Analytical 40 nil VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 819 Sutker Avenue,Ste.8 250 nil ITE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacramento,Ca 95834 500 ml I'M 3 <br /> Printed Name Printcd Name 916-921-9600 1 liter I1101s: 4 <br /> 500 nil glass: 5 <br /> Fimt Firm 1 liter glass: 6 <br /> 1'imc 2x6 s/s-fling: 7 <br /> Dalcrhilie Dale/ <br /> glass.jar: 8 <br />