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• r <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of <br /> IT/E41CON - 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: PO Number: 135498 OP <br /> (916)928-3300 FAX 91 928-3341 Lab: Sequoia Analytical <br /> Project Name: Barney Lane Landfill,San Joaquin County Anal sis Requested <br /> Project Number: IT#791290 <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevard <br /> Sacramento,CA 95834 <br /> Phone: (916)928-3300 U tJ <br /> FAX: (916)928-3341 <br /> Sampler's Signature: <br /> LAB -1-3 " REMARKS <br /> amp a f{: <br /> .r <br /> _ • �. Date Time I.D. Matrix :kr.-. <br /> Container Types <br /> .. ., NF Preservations <br /> R1W-3 tl a i water I 1 Ai 3 >, <br /> MW-4 water 1 1 r <br /> ItI+.I.INlj1114111>D It ' ItE('FIVED BY NTS TURNAROUND REPORT R <br /> RELINQUISHED BY RECEIVED BY E'Q1111 EMF, <br /> REQUIREMENTS <br /> ure luro X I. RoutineReport <br /> Siglwauy] S' SiipuSiiywturo <br /> n t, 241u rale 5 day H. Report(includes Ix Ip,Ats <br /> • X aWutud(•-10.15 wwiuia ays) A1SD,as ror uirad,ula ba <br /> 1 nulaJ Nunle 1 Y <br /> Printed Name Printed Nemo Provide Vubat Prowneuly Results �cltarged as samples) <br /> T J — Provide FAX Prebub vy Results <br /> Ill.Hata Validation Report <br /> I inu / <br /> �(a�� Firni <br /> Finn Firm <br /> u) ��W RepM W�: (includes All Raw Data) <br /> mftX RWQCI3 <br /> Daic I'in c Dat tTirlle Datelrune DaleJTinu; <br /> I0?I.IN01I15111?U 111' RF..FINED BY Special 1ltstructlolts/Conuttenls: (A4111-0'Ql-s(I-RACLA) <br /> Coulaln.:r Types hey: <br /> Sequoia Analytical 40 fill VOA: 1 <br /> �ign;durc signature Pieaue report:MDLs,PQI s,mid Truce. 819 Striker Avenue,Ste.8 250 fill LPE: 2 <br /> Sacramento,Ca 95834 500 ad I.PE: 3 <br /> h iniad Nam,; Primed Nwna ' <br /> 916 921-9600 1 liter 11D1'E: 4 <br /> _ flax-Cluoma has 24 hour hold limo. SUu,ui glass: <br /> t u w Finn <br /> I Ihcr glass: o <br /> I1.a. Iiw — —�-- Dalc"finis ?�/is•sring: 7 <br /> glass jai 8 <br />