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M = ® M ® M M M M M M ® ® M <br /> CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM Page—of <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: IT 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: I'1'#791289/16037-200.000 <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevard N <br /> Sacramento,CA 951334 U Q <br /> too <br /> Phone: (916)928.3300 0 <br /> FAX: (916)928-3341RI <br /> Sampler's Signature: 9o Viz > z1 1 1 1 1 1 1 1 1 IREMARKS <br /> Sample LAB ample 1 4 container Types <br /> I.D. a Time I.D. Matrix ael NP Preservations <br /> MW- Z x twater 4 3 1 SS-c C I Ll <br /> MW-: 3 / water 4 3 1 <br /> Field3lanl water 3 3 <br /> RE N D BY REC RELINQUISHED It RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Sriu Signature Signature u hr 48 to 5 day 11. Report(includes DUP,Mt <br /> {ftJ of X Standud(-10.15 working days) MSD,as required,may be <br /> Prin0, anfe Pr led N,gmeq Printed Name Printed Name Provide verbal Preliminary Results charged as samples) <br /> I <br /> r� Provide FAX Prelladuary Results III.Data Validation Report <br /> Firn Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> t L0 !1 I) -711q X RWQCB <br /> Date/tine Dale rime Dale/rime Date/time (MDLs/PQLs/rRACB#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDI.s,PQLs and Trace. 819 Striker Avenue,Ste.8 250 int LPE: 2 <br /> Nit rate-Nitrogen has a 48-hr hold time. Sacramento,Ca 95834 500 nil LPL: 3 <br /> Printed Nano Trialed Name 916-921-9600 1 liter HDPE: 4 <br /> 5000 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/rime Uale/lima glass jar: 8 <br />