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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page L of_ <br /> PO Number. OW#9200105 <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: <br /> 1EMCon (916)928.3300 FAX(916)928-3341 Lab: SPAR <br /> Project Name:Foothill Landfill,San Joaquin County Anal sis R nested <br /> Project Number. 16037-200.000 <br /> Project Manager. Steve Giacomini <br /> Com EMCON/OW <br /> PanY� <br /> Address: X433 North Market Boulevard00 <br /> Sacramento,CA 95834 u < o }`! <br /> Phone: (916)928-33Q0 `" o <br /> o z ? ' <br /> FAX: (916)928-3341 H a <br /> Sampler's Signature: <br /> a REMARKS <br /> 2 > Z Container T s <br /> amp a Sample t 4 <br /> Preservations <br /> I.D. Date TimI.D. Matrix HCl NP <br /> MW-1 a1 1 �y 1 nle <br /> water 3 2 1 <br /> MW-2 1�3r water 3 2 <br /> MW-3 1331* water 3 2 1 <br /> RE I Q Y RECEIV BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si Signature Signature 24 br 48 hr s day Il. Report(mcludes DUP.ye <br /> S' tura Ori'w'v Suoaard l-lo-t5 wmldoadays) MSD,as required,may b <br /> J O L✓�I Piovi4 verbal hakal my Rewlra durged as samples) <br /> Printed Printed Name Printed Name Primed N <br /> Provide FAX Palkalloy Rewtrs M.Data validation Report i <br /> Requested Repat naa: (includes All Raw Data) `' <br /> Run <br /> RWQCB <br /> n a firm Firm X ��/PQLsIIRA(�N) <br /> Da une / Daton"u to <br /> Container Types Key: T <br /> RE�JNQUISHED BY RECEIVED 1;Y Special instroctioaslCommeatx 40 rnl VOA- <br /> Ste. <br /> S , r Lab <br /> Signature ' SigRmm Please report MDLs,PQLs and Tx*ce. <br /> ;. 3050 Pito Cirde;Ste.1 l2 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacramento,Cs 95827 500 ml LPE: 3 <br /> 916-362-8947 l liter HDPE: 4 <br /> Printed Name Printed 500 ml glue:Name r <br /> 5 w <br /> I liter glass: 6 <br /> FiFirm 2a6 Vs ring: 7 <br /> nn <br /> lass <br />