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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 Anal sis Requested <br /> Project Number: 1T#791289 4 <br /> Project Manager: Steve Giacomini in <br /> Company: IT/EMCON b ,� <br /> Address: 1433 North Market Boulevar N <br /> Sacramento,CA 95 34 V 001 <br /> Phone: (916)928-3300 c , 9 % <br /> FAX: (916)928-3341 0 <br /> Sampler's Signature: b <br /> O U <br /> �. <br /> .. REMARKS <br /> Saltlple LAB Sample ] t 4 Container Types <br /> I.D. Date Time I.D. Matrix 1 HCl NP Preservations <br /> ater <br /> MW-3 1,�0 water 4 3 1 <br /> Ficld Blank 7-S water 3 3 <br /> KE N .1 Bl' K' 'EIYEll BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si Si ature Signature Signature 24 hr 49 hr 5 day 11. Report(includes DUP,MS <br /> X standard(-1a/5.mking days) MSD,as required,may be <br /> Printed N• P' ted Name Printed Name Printed Na9E[Leh -me Provide Ve"Prelim6ary Results charged as samples) <br /> Provide FAX Prelin inay Results III.Data Validation Report <br /> Firm Firm io Firm Firm Requested Report Date: (includes All Raw Data) <br /> �Oltflo (Otv I® X RWQCB <br /> Daterrime llale/I ime Datw Time Datw7ime (MD[s/PQ[s/1'RACE//) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types I) <br /> Signature Signature Please report MDl s,PQ1,s and Trace. Sequoia Analytical 25 nil VUA'. I <br /> 8t9 Striker Avenue,Ste.8 25U ml L.l f.. 2 <br /> Nitrate-Nitrogen has a 48-hr hold thee. Sacramento,Ca 95834 5001111 LPE: 3 <br /> Printed Name Printed Name <br /> 916-921-9600 1 liter HDPE: d <br /> 500 ml glass: 5 <br /> Film Kinn 500 <br /> liter glass: 6 <br /> 2At,s's ring. 7 <br /> Dat.:."fink I)alc'finu <br /> glass jar: 8 <br />