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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: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: IT#791289/16037-200.000 b <br /> Project Manager: Steve Giacomini a <br /> Company: IT/EMCON a <br /> Address: 1433 North Market Boulevard N W z <br /> Sacramento,CA 958 4 �j Q <br /> Phone: (916)928-3300 c <br /> FAX: (916)928-3341 a z <br /> Sampler's Signature: o v1 o <br /> z > Z REMARKS <br /> Sample LAB Sample 1 4 1 Container Types <br /> I.D. Pa - Time I.D. Matrix HCl NP Preservations <br /> MW- 2 [)/i water 4 3 1 <br /> MW 3 >lS) water 4 3 1 <br /> Field3lani 1 0 water 3 3 <br /> IT) LILL <br /> IDatefinie <br /> D BY REC RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS x 1. Routine Report <br /> tJ �l/► ga Signature Signature 24 to ae be s day II. Report(includes DUP,MS <br /> % f Swward(-la►s working days) MSD,as required,may be <br /> a Pr' ted N he Printed Name Printed Name Ptov(de Verbal heluuluary Results charged as samples) <br /> Provide FAX Preliaduary Results III.Data Validation Report <br /> Firm Firm Firm Id:queatedReportDate: (includes All Raw Data) <br /> f7� x RwQCB <br /> Date/Dnhe Date rime Dateflime (MULs/PQI-VI-RACE#) <br /> REI-INQUISHED BY RECEIVED BY Special lustructlons/Cosuments: Container Types Key: <br /> Sequoia Analytical 40 sill VOA: I <br /> Signature Signature Please repots MDIs,PQI.s and'Trace. 819 Striker Avenue,Sle.8 250 nd ITE: 2 <br /> Nitrale-Nitrogen has a 48-lir hold time. Sacramento,Ca 95834 500 nil LPH: 3 <br /> Prinlcd Name Pouted Name 916-921-9600 1 liter IIDPE: 4 <br /> StX)nil glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 sis ring: 7 <br /> I);nc/i'inle fh:dell'iute <br /> glass jar: 8 <br />