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w w ww w ww w w w® w ww w w® w ww <br />Rev. 1/99 <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br />UZ 1433 North Market Boulevard, Sacramento, CA 95834 P.O.: <br />tI1KG711 V l o VL5-JJUU V AAC V 10 VL5-J 141 Lao: <br />Project Name: <br />Analysis <br />Requested <br />Project Number: <br />Project Manager: <br />c <br />Company: EMCON <br />Address: 1433 North Market Boulevard <br />�j <br />Sacramento, CA 95834 <br />0 <br />Phone: (916) 928-3300 <br />- <br />FAX: (916) 928-3341 <br />E <br />Sam ler's Sip -nature: <br />z <br />REMARKS <br />Sample LAB Sample <br />Container Types <br />I.D. Date Time LD. MatriX <br />"....4 <br />Preservations <br />aaa <br />Signature <br />Date/Time <br />BY <br />Date/rime <br />TURNAROUND <br />REQUIREMENTS <br />24 IV 49 hr 5 day <br />Standard (-10.15 waking days) <br />Provide Verbal Preliminary Results <br />Provide FAX Preliminary Results <br />Requested Report Date: <br />CHAIN OF CUSTODY DOCUMENTATION <br />REPORT REQUIREMENTS <br />X 1. Routine Report <br />_ 11. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />_III. Data Validation Report <br />(includes All Raw Data) <br />RWQCB <br />tainer Types Key: <br />40 ml VOA: 1 <br />250 ml LPE: 2 <br />500 mlLPE: 3 <br />1 liter 11DPE: 4 <br />500 ml glass: 5 <br />1 liter glass: 6 <br />20 s/s ring: 7 <br />glass jar: 8 <br />FIGURE <br />- <br />