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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> IT CORPORATION-1326 North Market Boulevard,Sacramento,CA 95834 PO Number: <br /> 91 928-3300 FAX 91 928-3341 Lab: APCL <br /> Project Name: Harney Lane Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 791290 <br /> Project Manager: Steve Giacomini <br /> Company: IT CORPORATION <br /> Address: 1326 North Market Boulevard p o <br /> Sacramento,CA 95834 v U <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 <br /> Sampler's Signature: <br /> Z I I I IRENIARKS <br /> Sample LAB Sample Container Types <br /> I.D. Date Time I.D. Matrix a Preservations <br /> MW-3all water <br /> MW-4 1350 water <br /> TAVft AM <br /> INQUISHED BY RECE7ED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS I. Routine Report <br /> Si Si Lure n Signature Signature 24hr 48hr 5day II. Report(includes DUP,MS <br /> JW 1Lir X Standard(—tat5 woddnq days) MSD,as required,may be <br /> Printed Name Print d Naany Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> ZEPwvM 6L✓ Provide FAX Prelun nary Results X III.Data Validation Report <br /> Firm Firm Firm Finn Requested Report gate: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time to *rl2Q,wC qffAm b6te/Ti#(e Date/Time Date/Time (MDI s/PQl grrRACE#) <br /> RKLINQUty111$D BY REGIUVED BY hprctal IushYecllous/Comtnculs: Container Types Key: <br /> APCL 40 ml VOA: 1 <br /> Signature Signature "Level III report format. 13760 Magnolia Avenue 250 ml LPE: 2 <br /> Chino,CA 91710 500 ml LPE: 3 <br /> Printed Name Printed Name 909-590-1828 1 liter HDPE: 4 <br /> Hex-Chrome has 24 hour hold time. 500 rnl glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time :::jDateffime glass jar: 8 <br />