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/ CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page__ter_._._.. <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 PO Number: 135495 <br /> 916 928-3300 FAX 916)928-3341 Lab: Sequoia Analytical <br /> Project Name: North County Landfill Analysis R uested <br /> Prc lect Nuinber: 791288 <br /> Project Manager: Steve Giacomini g <br /> Company: IT/EMCON •� <br /> Address: 1433 North Market Boulevard <br /> Sacramento,CA 95834 j W <br /> Phone: (91 r)928-3300 <br /> o � <br /> FAX: (916)928-3341 wla?A <br /> Sampler's Signature: <br /> z REMARKS <br /> Sample LAB Sample 3 container Types <br /> I.D. Date Time I.D. Matrix ''"'''' NP Preservation-; <br /> G-4 water 1 1 <br /> RELIN UI5HED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature1 . ature Signature Signature 24 hr 48 h sday ll. Report(includes DUP,MS <br /> �f(�v nX 3W derd(—w-,$WxMgda") MSD,as required,may be <br /> Printed Name Printed amp_ Printed Name Printed Name Provide VerbelPrelrniuryRaub charged av samples) <br /> Provide FAX ProlisiaryRaub lli.Data Validation Report <br /> Firm Firm Firm Requested RepaA DO*: (includes All Raw Data) <br /> t7 1, w IV6q X RwQCB <br /> Date/Time DatelTime Date/Time Date/Time (MDIA/PQLa/TRACEN) <br /> RELINQUISHED BY RECEIVED BY Speclai Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 mi VOA: 1 <br /> Signature Signature "Report MDIA,PQLs,and Trace. 819 Striker Ave,Suite 8 123 ml LPE: 2 <br /> Sacramento,Ca.95834 500 ml LPE: 3 <br /> Printed Name Printed Name 916.921-9600 1 liter LPE: 4 <br /> Ron or Sandi 500 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> DatelTime DatcJ Time I glasa jar: 8 <br />