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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> IT/EMCON-1433 North Market Boulevard,Sacramento,CA 95834 IT P.O.No: 135497 <br /> (916)928-3300 FAX 91 928-3341 .1Lab: Sequoia Analytical <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: IT#791289/16037-200.000 c <br /> Project Manager: Steve Giacomini <br /> Company: IT/EMCON00 <br /> Address: 1433 North Market Boulevard :% o <br /> 00 <br /> Sacramento,CA 95834 -< <br /> Phone: (916)928-3300 zb R 1..� <br /> co <br /> O <br /> FAX: (916)928-3341 <br /> Sampler's Signature: Z. <br /> * 00 0000U + <br /> 5o <br /> w <br /> U REMARKS <br /> Sample LAB Sample 4 1 1 6 4 1 4 4 3 Container Types <br /> I.D. Date Time I.D. Matrix NP HCl HCI NP HNO3 NaOH -- NP Preservations <br /> MW-3 Iff 12 Ir water 15 1 3 3 4 1 1 1 1 SQ'q V4Z-of <br /> l<Ic� <br /> 'U <br /> RELINQUISHED BY ` IVED B RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si tore Si Signature Signature 2419 48 hr 5 day II. Report(includes DUP,MS <br /> S-PX Standard(-10.15 worldng days) MSD,as required,may be <br /> 26 <br /> Printed Name ame Printed Name Printed Name Provide verbal Preliminay Resutts charged as samples) <br /> 17- p Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm <br /> f,Z � /6 l/ Requested Report Date: (includes All Raw Data) <br /> ( f�� X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQL rrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Sequoia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDIs,PQLs and Trace. 819 Striker Avenue,Ste.8 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Sacramento,Ca 95834 500 ml I.PE: 3 <br /> Printed Name Printed Name Metals: Al,As,Sb,Pb,Ba,Hg,Be,Ni,B.Se,Cd,Tl,Cr, 916-921-9600 1 liter HDPE: 4 <br /> Co,Cu,Fe,Mn,A=,Sn,V,Zn(Field Filtered). 500 ml glass: 5 <br /> Finn Finn 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> DatdTime Date/Time glass jar: 8 ► <br />