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i� CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page of <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: �PO Nnirtiber #92801'57 <br /> 9MCOn (916)928-3300 FAX(916)928-3341 Lab: SPARGER <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 16037-200.000 <br /> Project Manager: Steve Giacomini N <br /> Company: EMCON/OWT , <br /> Address: 1433 North Market Boulevard N r; 0 <br /> Sacramento CA 95834 0 00 N <br /> Phone: (916)928-3300 4U„ W <br /> FAX: (916)928-3341 0 <br /> Sampler's Signature: o <br /> z > z REMARKS <br /> amp aLAB Sample 1 4 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP Preservations <br /> MW-1 ��� �OSa water 3._ 2 1 <br /> MW-2 13a — water 3 2 1 <br /> MW-3 4 3o water 3 2 1 <br /> RELINQUISlMTrBX RECEIVEDAW RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> t 11at�ur((e gnature Signature Signature 24 hr _48hr 5 day II. Report(includes DUP,MS <br /> LV 1 L erL-+►9 standurd(-10-15 working days) MSD,as required,may he <br /> Printed Nam Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> W Provide FAX PreIvnmaryResults 111.Data Validation Report <br /> Firm / J Firm/ Firm Firm Requested Report Date: (includes All Raw Data) <br /> 16 C/I / 7 16 W X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> SpargesYLah .y 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace.' 250 ml LPE: 2 <br /> .. , <br /> Nitrate-Nitrogen has a 48-hr hold time. Saoram®nto.ICa°95R27 500 ml LPE: 3 <br /> Printed Name Printed Name 1%462-8947e f I liter HDPE: 4 <br /> 500 ml glass: 5 <br /> Firm Firm I liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time Date/Time glass jar: 8 <br />