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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page__ of_ <br /> 1T CO It PO RATION- 1433 North Market Boulevard,Sacramento,CA 95834 IT P.O.No: <br /> (916)928-3300 FAX(919 928-3341 Lab: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791289 g <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON o <br /> Address: 1433 North Market Boulevard N rn a, <br /> Sacramento,CA 95834 00 , <br /> Phone: (916)928-3300 44 <br /> PAX: (916)928-3341 C V <br /> Sampler's Signature: d�r1y� a " <br /> REMARKS <br /> Saluple LAB Sample 1 4 Coataincr'I'ypes <br /> _ Ll). Date Time I.D. Matrix ticq NP Preservations <br /> MW-1 1 t P 1 water 4 3 1 9 1U ` <br /> M\V-2 / water 4 3. 1 <br /> f 4W- water 4 3 1 <br /> Field 131ank I IS ot 1323 water 3 3 <br /> water 2 2 <br /> cU <br /> RFIdNQUIS11ED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQI111,REMENTS <br /> "? ' V1 REQUIREMENTS X 1. Routine eporl <br /> Sign e� + ' s _44 ) t re Signature Signature 14k 4shr 5day H. Report(includes DUP,MS <br /> /J "`1- el Z MSD,as required,may be <br /> Printed Name Printed Name r Printed Name Printed Name Provide VerbalhaminnyResults charged as samples) <br /> Provids FAX hdm ira y Rauhs III,Data Validation;Repots <br /> Finn Fiq� Firm Firm RequesWRep dDaW.. (includes All Raw Data) <br /> I �(� C9ZC1 lIItp X RWQCII <br /> Da I'in c Date/Time Datefrime 113alafrime (MDLs/PQI.VI'RACr•.t/) <br /> 11FLINQUIS11FI)BY RECEIVED BY Special Instructions/Conunents: Container'1')Pes Ivey: <br /> Sequoia Analytical 40 ml VOA: I <br /> Signature Signature Please report MDLs,PQLs and Trace. 819 Striker Avenue,Ste.8 240 ml I TF: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacrunento,Ca 93834 500 ml ITE: 3 <br /> Printed Name Printed Name 916.921-9600 1 liter 111011: 4 <br /> 500 nil glass: 5 <br /> Finn Firm I liter glass: 6 <br /> 2x6&Is ring: 7 <br /> Date/Tinie jDatefrime I glass jar: 8 <br />