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CEL41N OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of <br /> EMCONfOWT Inc. � ,,o^� � f P.O.No: 74815 <br /> 1326 North Market Bou levar Sacramento CA 95834 `�' Lab: CAS,Canoga Park,Ca <br /> Project Name:Iii ty La"nriM S to Joaquin County Anal sis Requested- <br /> First Storm-Ewj#1.200512006i'_Semn r:: <br /> Project Number: 791288/00005000 -: " <br /> t <br /> Report to: Sheila Richgels <br /> Company: EMC®N/OWT Inc. �f ` <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 w, <br /> Phone: (916)5654327 / FAX: (916)565-4 6 A <br /> Sampler's Signature: <br /> L- REMARKS <br /> Sample LAB Sample 4 Container Types <br /> I.D. Date Time I.D. Matrix NP Preservations <br /> S-1 -3-c ics5' water 2 2 <br /> S-2 water 2 2 <br /> S4 , water 2 2 <br /> RELINQUISHED BY RECEIVED BY .- RELINQUISHED BY RECEIVED YTURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signa Signature Signature Signature 2. 24 hr ®48 hr 5 day 11. Report(includes DUP,MS <br /> ".& I I unn'i? /,"� standard t-talc working days) MSD,as required,may be <br /> Nted Na Printed Name Printed Name Printed Name Provide Verbalpreliminary Results charged as samples) <br /> v 1 f� Provide FAX Preliminary Results III.Data Validation Report <br /> FinS Firm Firm Fi <br /> ( Requested Repos Date: (includes All Raw Data) <br /> .,, , <br /> tr X RWQCB <br /> Date/Time )-3--cad, Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Chlutnliia.Anaiiytical 40 ml VOA: I <br /> Signature Signature Report MDLs,PQLs,and Trace. 6925 Conaga Avenue 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Canoga Park,Calif 91303-3102 500 ml LPE: 3 <br /> Printed Name Printed Name Lab Contact: Stuart Sigman I liter HDPE: 4 <br /> 818-587-5550 x310 500 ml glass: 5 <br /> Firm Firm Fx.818-587-5555 1 liter glass: 6 <br /> Ship FedX Acct 1435-1381-5 2x6 s/s ring: 7 <br /> DatelTime <br /> Date/Time glass jar 8 <br />