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CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM Page-Lof / <br /> IT/EMCON-1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: PO Number: 135498 OP <br /> 91 928-3300 FAX 91 928-3341 Lab: Se oia Anal 'cal <br /> Project Name: Harney Lane Landfall,San Joaquin County Anal ' R uested <br /> Project Number: IT#791290 <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON g� <br /> Address: 1433 North Market Boulevard <br /> Sacramento,CA 95834 j <br /> Phone: (916)928-3300 46 <br /> FAX: (916)928-3341 y <br /> Sampler's Signature: �nZ' P0 <br /> REMARKS <br /> limp e LAB Sainple 3 ContainerT <br /> I.D. Date Time I.D. MatrixNP Preservations <br /> ns <br /> t l ®roJAI;--)726water 1 1 <br /> MW-4 water 1 1 <br /> RELINQUI EDB RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signa S' " Signature Signature 24 hr 48 hr 5 day II. Report(includes DUP,MS <br /> J i x standard(-10-15 working days) MSD,as required,may be <br /> Printed Name Priruted Name Printed Name Provide verbelPremnataryResti is charged as les <br /> �P ) <br /> T Provide FAX ProliminaryRosuka III Data Validation Report <br /> FirmF' Firm Firm Requested Report Date: (includes All Raw Data) <br /> it&'["-> IGScmtzoio I X RWQCB <br /> Datefrirra Dawrime 56 Date/Time jDaterime (MDLs/PQLwTRACE#) <br /> RELINQUISHED BY RE&WED BY Special Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 ml VOA- <br /> Signature <br /> OASignature Signature Please report MDLs,PQLs,and Trace. 819 Striker Avenue,Ste.8 250 ml LPE: 2 <br /> Sacramento,Ca 95834 500 ml LPE: 3 <br /> Printed Name Printed Name 916-921-9600 1 liter HDPE: 4 <br /> Hex-Chrome has 24 hour hold time. 500 ml glaw: 5 <br /> Firm Firm l liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> DatelTime Dat.Timo glassjar g <br />