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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: IT P.O.No: 135497 OP <br /> (916)928-3300 FAX(919 928-3341 Lab: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: IT#791289/16037-200.000 <br /> Project Manager: Steve Giacomini a <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevar N rn 121 t <br /> Sacramento,CA 9 U Q ,� <br /> Phone: (916)928-3300 p" ° <br /> FAX: (916)928-3341 v <br /> Sampler's Signature: > Q 2 <br /> t-� REMARKS <br /> Sample LAB Sample 1 4 Container Types <br /> I.D. 4te Time I.D. Matrix HCl NP Preservations <br /> MW-1 water 4 3 1 5 <br /> O Ial— <br /> MW-2 wet <br /> MW-3 water 4 3 1 <br /> Fiel ank water 3 3 <br /> RELI D BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signat Signature Signature Signature 24ld 481u 5 day II. Report(includes DUP,MS <br /> X Standard(-10-15 worldng days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as aamples) <br /> Provide FAX Prdaninary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> 9, 00 X RWQCB <br /> Date/Time Date/Time Date/Time Daterrime (MDLs/PQI-&TRACE#) <br /> RELINQUISIIED BY RECEIV D Y --_\SpecialInstructIons/Comments: Container Types Key: <br /> -y Sequoia Analytical 40 ml VOA: 1 <br /> Signature Stgnattrro Please report MDLs,PQLs and Truce. 819 Striker Avenue,Ste.8 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr bold time. Sacramento,Ca 95834 500 ml LPE: 3 <br /> Printed Name Prinle NWe 916-921-9600 1 liter HDPE: 4 <br /> •_. -) t� 500 ml glass: 5 <br /> Finn Fi I liter glass: 6 <br /> 20 s/s ring: 7 <br /> Dae/Tinto IDdefrilie glass jar: 8 <br />