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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(916)928-3341 Lab: Se uoia Anal ical <br /> Project Name: Foothill Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 1T#791289/16037-200.000 <br /> Project Manager: Steve Giacomini a <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevar N rn <br /> Sacramento,CA 9 U 00Phone: (916)928-3300 c W c <br /> FAX: (916)928-3341 <br /> Sampler's Signature: �O j Cod, <br /> REMARKS <br /> Sample LAB Sample *Slf, 1 4 1 Container Types <br /> I.D. •to Time I.D. Matrix } HCI NP Preservations <br /> MW-1 water 4 3 1 <br /> MW-2 wat <br /> MW-3 water 4 1 3 1 1 <br /> Fiel ank water 3 3 <br /> f <br /> RMID RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> SiSignature Signature Signature 241u 48 Ia 5 day 11. Report(includes DUP,MS <br /> X Standard(-10.15 working day.) MSD,as required,may be <br /> Printed Name Printed Nano Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results 111.Data Validation Report <br /> Finn ` J ^ Finn Firm Finn Requested Report Date. (includes All Raw Data) <br /> 1 X RWQCB <br /> Date/Time Dale/Time Date/Ti me Date/Time (MDIs/PQLWTRACE#) <br /> RELINQUISHED BY _. RECEIV D Y Special Instructtuns/Consinents: Container Types Key: <br /> Sequoia Analytical 40 nil VOA: 1 <br /> Signature Srirratyrel Please report MDLs,PQLs w14.1 race..- '' 819 Striker Avenue,Ste.8 250 to[LLE: 2 <br /> Nitrate-Nitrogen hus a 48-hr huld those. Sacrament%Ca 95834 500 nil ITE: 3 <br /> Pruned Name Printedm <br /> Ni3c 916-921-9600 1 liter IIDPE: 4 <br /> C 500 ml ghm: 5 <br /> firm I liter glass: 6 <br /> Fi o <br /> 2x6 s/s ring: 7 <br /> Date/Time Da a/Gime glass jar: 8 <br />