Laserfiche WebLink
Rev.1/99 <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORINT <br /> 1433 North Market Boulevard,Sacramento,CA 95834 P.O.: <br /> Emc00 91 928-3300 FAX 91 928-3341 Lab: <br /> Project Name: Analysis R uested <br /> Project Number: y <br /> Project Manager: <br /> Company: EMCON t0 <br /> Address: 1433 North Market Boulevard 0 <br /> U <br /> Sacramento,CA 95834 `a <br /> Phone: (916)928-3300 <br /> PAX: (916)928-3341 <br /> Sampler's Signatu z I I I REMARKS <br /> Sample WB Sample I I I lContainerT <br /> I.D. Date Time I.D. Matrix ``'' <br /> Preservations <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr_48 hr 5 day II. Report(includes DUP,MS <br /> 7C StaruPa�d(—Po-1. rias days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Fmvide Va&W Preurninary Resaira charged as samples) <br /> Fronde FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report pare: (includes All Raw Data) <br /> RWQCB <br /> DatwTime Date/Time Date/rime, Date/Time Ls/P Ls/rRACEH <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> 40 ml VOA: I <br /> Signature Signature 250 ml LPE: 2 <br /> 500 ml LPR 3 <br /> Printed Name Printed Name I liter HDPE: 4 <br /> 500 mi glass: 5 <br /> Firm Firm I liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time jDaterime lass'ar. 8 <br /> w' FIGURE <br /> COZY WATER SAMPLE FIELD DATA SHEET A®3 <br />