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CHAIN OF CUSTODY/LABORATORY ALYSIS REQUEST FORM Page—of- <br /> 1433 <br /> age_of-1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: PO Number: OWT#9200105 <br /> EIMt011 (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 b <br /> Project Manager: Steve Giacomini <br /> Company: EMCON I OWT <br /> Address: 1433 North Market Boulevard <br /> Sacramento,CA 95834 u ° <br /> Phone: (916)928-3300 0 <br /> FAX: (916)928-3341 <br /> Sampler's Signature: <br /> z E~ z REMARKS <br /> Sample LAB Sample 4 ContainerDEs <br /> I.D. Date Time I.D. Matrix NP Preservations <br /> S-1 water 1 1 <br /> S-2 water 1 1 <br /> NAN <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 Lr 48 it s day 11. Report(mcludes DUP,MS <br /> sunaxut-tau rodftaays> MSD,as required,may be <br /> Printed Narne Printed Nates Printed Name Printed Name Pmvide Ve,ne Ph irobary Resatued <br /> � as saurP les) <br /> Provide FAX PxHathimy Resdu M.Data Validation Report <br /> Firm Firm Firm Fimn Regwmd Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/time Date ime DateTirne umo (MDLs/PQLs/IRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instmetions/Comments: Container Types Key: <br /> Sparger Lab 40 ml VOA: 1 <br /> Signature SipaAue r po 3056Fite Circle,Ste.112 250 ml LPE: 2 <br /> Nitrate-Nitrogen'has s 4&hr hold time. Sacramento,Ca 95827 500 tel LPE: 3 <br /> Printed Name Printed Name 916-362-8947 l liter HDPE: 4 <br /> 500 ml glass: 5 <br /> Finn Firm <br /> 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date,Tune Date.Time <br /> lass 1E. 8 <br />