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M M M M M M ® M ® M M M ® M M ® ® M <br />CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM Page _ of _ <br />IT / EMCON - 1433 North Market Boulevard, Sacramento, CA 95834 Service Request No: IT P.O. No: 1.0 <br />(9 161 928.3311(1 FAX (91 61 928.3341 1 nk- co,.. :., A..ae..rl-11 <br />Project Name: Foothill Landfill, San Joaquin County <br />Project Number: IT# 791289 / 16037-200.000 <br />Pr jest Manager: Steve Giacomini <br />Company: IT/ EMCON <br />Address: 1433 North Market Boulevard <br />Sacramento, CA 95834, <br />Phone: (916) 928.3300 <br />FAX: (916) 928-3341 <br />Sampler's Signature: <br />Analysis Re uested <br />w <br />z <br />^ <br />c <br />�' <br />c <br />U o <br />q z <br />N Q U <br />j 04 <br />b <br />L.4)o z® <br />q <br />O <br />^� <br />O <br />"`� <br />a <br />w <br />®�^ <br />z <br />N 0 <br />ry <br />U <br />x <br />O <br />z <br />;° U <br />a <br />to N <br />P°It <br />� <br />> <br />o <br />U <br />-*©4G+ <br />a5 per 5Ie�G ' <br />Ilas/00 l ' <br />REMARKS <br />Sample <br />I.D. Date <br />LAB <br />Time I.D. <br />Sample <br />Matrix <br />4 <br />1 <br />3 <br />6 <br />4 <br />4 1 <br />4 <br />3 <br />lContainer Types <br />NP HCl <br />H2SO4 <br />HCl <br />HNO3 <br />NaOH <br />NP <br />Preservations <br />S-1 $ Da <br />%W <br />water <br />11 <br />1 <br />3 <br />1 <br />2 <br />1 <br />1 <br />1 <br />l <br />S-2 <br />® a <br />water <br />1 1 <br />1 <br />3 <br />1 <br />2 <br />l <br />1 <br />1 <br />REI IN U ED BY <br />AA <br />REC IV DB <br />LINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REQUIREMENTS <br />24 hr 48 hr 5day <br />X Standard (-10.15 working days) <br />Provide Verbal Preliminary Results <br />Provide FAX Preliminary Results <br />Reyaestea Report pate: <br />REPORT <br />X <br />X <br />REQUIREMENTS <br />1. Routine Report <br />11. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />111. Data Validation Report <br />(includes All Raw Data) <br />RWQCB <br />(MDLs/PQLsfrRACE#) <br />tur <br />Sign lure <br />tl� <br />Signature Signature <br />me N <br />Print d Name <br />Printed Name Printed Name <br />Firm <br />Ql5 <br />Firm <br />'` EX7 la <br />Firm Firm <br />Dn.,.rr me <br />Date?Time <br />Date/time Date/time <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/Comments: <br />Please report MDLs, PQLs and Trace. <br />Nitrate -Nitrogen has a 48 -hr hold time. <br />Metals: At, As, Sb, Pb, Ba, Hg, Be, Ni, B, Se, Cd, Tl, Cr, <br />Cu, Cu, Fe, Mn, Ag, Sri, V, Zn (NOT Filtered). <br />Sequoia Analytical <br />819 Striker Avenue, Ste. 8 <br />Sacramento, Ca 95834 <br />916-921-9600 <br />Container Types Key: <br />40 nil VOA: I <br />250 nil LYE: 2 <br />500 ml LPE: 3 <br />1 liter HDPE: 4 <br />500 ml glass: 5 <br />I liter glass: 6 <br />20 s/s ring: 7 <br />glass jar: 8 <br />Signature <br />Signature <br />Printed Name <br />Printed Name <br />Firm <br />Firm <br />Daterrime <br />Date/Time <br />a(OI►+n <br />