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_ CHAIN OF CUSTODY 1 LABORATC Y ANALYSIS REQUEST FORM <br /> IT CORPORATION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Ord <br /> 916)928-3300 FAX 916)928-3341 Lab <br /> Project Name Don Rodgers Analysis Requested ?7 e 7-&-,-- p <br /> Project Number 8800391A/01030000 <br /> Project Manager ?�j l <br /> Company IT CO ORATION 3 [ <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 <br /> U <br /> Phone .3390 o <br /> FAX (916)928-3341 �. W <br /> Sampler's Signature �--fS v0- <br /> z REMARKS <br /> Sample LAB Sample s Container Types <br /> ID at Time I D Matrix nra Preservations <br /> INFL X <br /> REI DISHED BY RE E ED BY RELIN UISHED REC VED BY TURNAROUND REPORT REQUIREMENTS <br /> k 'JE <br /> REQUIREMENTS X I Routine Report <br /> Signature ignature r Signature 24 hr 48 hr 5 day iI Report(includes DUP,MS <br /> «illy K Standard(-10-15 worlang days) MSD,as required,may be <br /> ted Name Printed Name Pnnted Name Printed Name Provide Verbal Prehmmary Results charged as samples) <br /> Tin R Wright Provide FAX Prctunntary Result, III Data Validation Report <br /> Firm Firm Fim Firm Requested Report Date (includes All Raw Mata) <br /> IT Corporatlop RWQCB <br /> Date/Time 'Z Dat e D DateJTune (MDLa/PQLsfIRACE#) <br /> REL114QU19HED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature ! 250 ml LPE 2 <br /> Printed Name Printed Name 305D 500 ml LPE 3 <br /> e 1 liter HDPE 4 <br /> ��G�,-/ 500 ml glass 5 <br /> Firm Ftmt <br /> �y�� ,3lDZ �� �Z�` Iliter glass. 6 <br /> ! " ' <br /> 2x67 <br /> Da Dat }�L41 <br /> 8 <br />