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so <br /> CHAIN OF CUSTODY I LABORA Y ANALYSIS REQUEST FORM <br /> IT CORPO nON-1326 North Market Boulevard,Sacramento,CA 93834 Purchase Order ZZ d3��;7 <br /> (916)928-3300 FAX(916)928-3341 imbF <br /> Protect Name Don Rogers A WysLs Requested s <br /> Project Number 880039 1A f 01030000 <br /> Project Manager Kathleen Waldo <br /> Company IT CORPORATION <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 U <br /> Phone 916-565-43701 916-565-4k5 w, <br /> 0 <br /> Sautpler"s Signature x <br /> REMARKS <br /> amp a LAB -Sample. r e g 1 Container Types <br /> ID PaTune ID Matrix ( 'Pedlar Preservations <br /> Infl en Au I I <br /> EM Air I 1 <br /> I <br /> I <br /> RELIN HE') -D BY�1 R IVED BY � �Z 'RELINQUfSHEU 8 CEIVEII B TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signature 1 r Signature 24 hr 411 hr s day U Report(includes DUP,MS <br /> r sand..;(-lals-rims days) MSD,as required,may be <br /> nOcd Nam t Printed Namc Panted Name Printed Name Prwn&Verbal Petry IWula charged as samples) <br /> vel rftwA&F utvras, y k"wtx III Data Valsdawn Raport <br /> FUM Frim Firm Requestedtieportthu (includes All Raw Data) <br /> `tom tI t Z tad O� RWQCB <br /> DatcfTtmc rine D tine D une (MDLslPQLslI'ItACE#) <br /> RELINQUBHED BY RECEIVED BY Special InstruchonslCommeuts. Container Types Key <br /> 44 ml VOA I <br /> Stpuature Signature 125 tnl LPI: 2 <br /> Sparger Tech 500 ml LP>y 3 <br /> Printed Name Pruned Name 3050 Fite Cucle,Ste 112 1 liter HDPE 4 <br /> Saito,Calif 95827 504 ml glass $ <br /> Firm Firm 916.362-89471 Fx 362-0947 1 liter Mass 6 <br /> DaW Ttme IDatwTime <br />