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M <br /> CHAIN OF CUSTODY / LABORATORYANALYSIS REQUEST FORM age o _ <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: PO Number: OWT#9200105 <br /> IMC011 (916)928-3300 FAX(916)928-3341 Lab: SPARGER <br /> Project Name:Foothill Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 16037-200.000 <br /> IN <br /> Project Manager: Steve Giacomini <br /> Company: EMCON/OWT <br /> Address: 1433 North Market Boulevard N <br /> Sacramento,CA 95834 t j Q d <br /> Phone: (916)928-3300 a o <br /> o W o <br /> FAX: (916)928-3341 ; .a U <br /> Sampler's Signature: U "i <br /> L <br /> 9 z REMARKS <br /> amp e LAB Sample 1 4 Container Types <br /> I.D. DateTime I.D. Matrix HCl NP Preservations <br /> MW-1 Ll I M111 1 3S water 3 2 1 <br /> MW-2 }"}3S' water 3 2 1 <br /> MW-3 l33'S' water 3 2 1 <br /> RE I Q Y RECEIV BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> S' tura Sign tur � Signature Signature 241n as br s day II. Report(includes DUP,MS <br /> Jo 1/6'rx mc. 901LOL, standard(-tats workingdays) MSD,as required,may be <br /> Printed Nam Printed Name Printed Name Printed Name Provide Verbal Prelunmary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Fi Firm Firm Requested Report Date: (includes All Raw Data) <br /> ti qq 4 X RWQCB <br /> Da une Dat Date/rime Date/rime (MDLs/PQLs/IRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Sparger Lab 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 3050 Fite Circle,Ste.112 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacramento,Ca 95827 500 ml LPE: 3 <br /> Printed Name Printed Name 916-362-8947 1 liter HDPE: 4 <br /> 500 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/time Date/rime glass jar 8 <br />