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CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM Page_of— <br /> IT/EMCON- 1433 North Market Boulevard,Sacramento,CA 95834 Service Request No: PO Number: <br /> (916)928-3300 FAX(916)928-3341 Lab: Sequoia Analytical <br /> Project Name: Corral Hollow Landfill,San Joaquin County Analysis Requested <br /> Project Number: 809251 /01010000 <br /> Project Manager: Mark Capps <br /> Company: IT/EMCON <br /> Address: 3939 Cambridge Road,Suite 220 •S <br /> Cameron Park,CA 95682 <br /> Phone: (530)676-6881 U <br /> FAX: (530)676-6885' <br /> o � <br /> Sampler's Signature: 0N0 <br /> W REb4ARKS <br /> Rample LAB Sample 1 Container Types <br /> I.D. Date Time I.D. Matrix HCI Preservations <br /> MW-541-�Lv 6)q-0 water 3 3 -- <br /> • <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signature Signatu - Signature Signature 24 hr as hr 5 day 1I. Report(includes DUP,MS <br /> Standard(-10.15 working days) MSD,as required,may be <br /> Printed Name P' to a Printed Name Printed Name Provide venal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results 111.Data Validation Report <br /> F11791 <br /> () Firm. Firm Firm Requested Report nate: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Datelfime '? ',,)7 Date rime Date/Time (MDL,/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 ml VOA: I <br /> Signature Signature 819 Striker Avenue,Ste.8 250 nil LPE: 2 <br /> Sacramento,Calif 95834 500 ml LPE: 3 <br /> Printed Name Printed Name 916-921-9600 1 liter IIDPE: 4 <br /> 500 ml glass:, 5 <br /> Firm Firm I liter glass: 6 <br /> 20 s/s ring: 7 <br /> Date/Time ime Date/I'ime glass jar: 8 <br />