Laserfiche WebLink
CHAIN OF CUSTODY/LABORATORYANALYSIS REQUEST FORM Page_of_ <br /> EMCON/OWT Inc. P.O.No: 211868 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab: Sequoia Analytical,Sacto <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791289/00001000 <br /> Project Manager. Steve Giacomini o <br /> Company: EMCON/OWT Inc. L <br /> Address: 1326 North Market Boulevardrzi <br /> Sacramento,CA 95834 U <br /> Dir Ph: (916)565-4335 / FAX: (916)565-435644 <br /> w p O0 a pq <br /> 0 <br /> _ ° 8 v e <br /> Sampler's Signature: ��, ' � �+ z wro U � 00 <br /> of � <br /> A (j REMARKS <br /> Sample AB Sample 3 4 1 1 JContaincrTypes <br /> I.D. Date Time I.D. Matrix HNO3 NP HCl lPreservations <br /> MW-2 S m%57 water 5` 1 1 3 <br /> LW-1 I'LWS" water 5 1 1 3 <br /> Trip Blank 9-V-01 water 2 2 <br /> Q� _DISHED BY I EIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REM <br /> QUIREE X I. Routine Report <br /> Si S' a Signature Sign u nr 48 b X s aay II. Report(includes DUP,MS <br /> -._ Vn 61 sm�aaa.d((-rals MSD,as required,may be <br /> Printed Name PAnted Name Printed Name Printed Name Pmvi&Vamd PMWr4ry Reaalts charged as samples) <br /> 5;401� )iPmvide FAX Preliminary Roulu III.Data Validation Report <br /> Firm F' c Firm Firm RequWW Repan Due: (includes All Raw Data) <br /> v5 X RWQCB <br /> DatelTime DativiTime Date/time DatdTime (MDLs/PQLsfrRACE#) <br /> RELINQUISHED.BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> p�4;�6 Sequoia Analytical 40 ml VOA: 1 <br /> S,gnature Signature Please report Ls,PQLs and Trace. 819 Striker Avenue,Ste.8 250 mi LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacramento,Ca 95834 500 ml LPE: 3 <br /> Printed Name Printed Name 916-921-9600 1 liter HDPE: 4 <br /> Contact: Ron Chew 500 ml glass: 5 <br /> FinnFirm l liter glass: 6 <br /> 2X6 s/s ring: 7 <br /> Date/1"une "Datefrime glass jar: 8 <br />