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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> IT/EMCON-1433 North Market Boulevard;Sacramento,CA 95834 PO Number: 135495 <br /> (916)928-3300 FAX 91 928-3341 Lab: Se uoia Analytical <br /> Project Name: North County Landfill Anal is Requested <br /> Project Number: 791288 <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON <br /> Address: 1433 North Market Boulevard <br /> Sacramento,CA 95834 U U d <br /> Phone: (916)928-3300 c <br /> FAX: (916)928-3341 11 w <br /> Sampler's Signature: �, �JV1 -- .� a <br /> Sample L am a REMARKS <br /> p 3 Container Types <br /> I.D. Date Time I.D. Wtrix NP Preservations <br /> G-4 t 2 t w t :..water I.... I <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature '� e <br /> o 1 Signature Signature 24 Lr 48 hr 5day 11. Report(includes DUP,MS <br /> X standard(-10.15 working days) MSD,as required,ma be <br /> Printed Name Printed etas Printed Name Printed Name y <br /> ) Provide Verbal charged as samples) <br /> I innProvide FAX Preliminary Results III.Data Validation Reportrl m1 Firm Finn Requested Report Data: <br /> P (includes All Raw Data) <br /> ut X RWQCI1 <br /> Date/l'ime Date(rime —4 Date/Tinle Ua1C/I'ime (MDLs/PQLslI'RACE#) <br /> REIdNQ111S11ED BV RECEIVED BY Special Instructlons/Conmrents: Container Types Ray: <br /> Sequoia Analytical 40 all VOA: ! <br /> Signattue <br /> Signature *Report MDLa,PQIs,arrd'rrace. 819 Striker Ave,Suite 8 125 ml ITH: 2 <br /> Sacramento,Ca.95834 500 nil L.PE: 3 <br /> l'riul.d Name 1'riutuJ Name 916-921-9600 1 liter ITE: I <br /> Ron or Sandi <br /> Firm Firm 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> 1).du"I inns 2x6 s/s ring: 7 <br /> Data/rime <br /> ---------...---__..._� n+,lassjar: X <br />