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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM <br /> IT CORDO ^ION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order #189246 _ 2002' <br /> (916)928-3300 FAX(916)928-3341 Lab Sparger Technology <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01030000 <br /> Project Manager Kathleen WaldoEli <br /> N <br /> Company IT CORPORATION L. 00 <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 U00 <br /> Phone 916-565-4370 / FAX 916-565-4356 ` w <br /> Sampler's Signature ,.rF <br /> = REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I D patp Time I D Matrix Tedlar Preservations <br /> Infl /C ?-o Air l I <br /> UP Air 1 1 <br /> RELINQUISHED BY RE EIVED BY RELINQUISHED B RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S atu Sign Signa re r Signature 24 hr 48 hr 5 day Il Report(includes DUP,MS <br /> AT <br /> Standar714.15 working days} MSD,as required,may be <br /> to amePunted Name Punted Name . 4z-� <br /> Printed Name Provide Verba]Preliminary Results charged as samples) <br /> r Provide FAX Prehmmary Results III Data Validation Report <br /> Firm �f'i �r , Firm F2�- Zl- <br /> Firm Requested Report nate (includes All Raw Data) <br /> .Yl �-G ,� —50 HMDLML&rMACE#) <br /> WQCB <br /> Date(rime p Date(rime DatelTun Date/Tune <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 m]VOA 1 <br /> Signature Signatu 125 ml LPE 2 <br /> Sparger Tech 500 m!LPE 3 <br /> Printed Name Punted Name 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> yE� Sacto,Calif 95827 500 ml glass 5 <br /> Firm Fi 916-362-8947/Fx 362-0947 1 litAks <br /> 6 <br /> a r U 2x6 7 <br /> Datefrime e g <br />