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mesa*= = mmm mm = = M w i i <br /> CHAIN OF CUSTODY / LABORATCW ANALYSIS REQUEST FORM -T <br /> IT CORPORATION - 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order l' <br /> (916)928-3300 FAX (916)928-3341 Lab <br /> Project Name Don Rodgers Anal sis Requested <br /> Project Number 9900391A/01030000 <br /> Project Manager K1rrQ*AJN L;:t(,40 Ln <br /> Company IT CORPORATION <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 0 <br /> Phone (916)928-3300 , c <br /> FAX (916)928-3341 �7 " pq <br /> Sampler's Signature <br /> z 0 REMARKS <br /> Sample LAB Sample 8 Container Types <br /> ID Date Time ID Matrix nra Preservations <br /> INFL ;920 t l X <br /> EFFL E I X <br /> i <br /> RELINQUISHED BY RE ' IYED Y ttE INQUISHED BY LVED BY TURNAROUND REPORT REQUIREMENTS <br /> r REQUIREMENTS X I Routine Report <br /> St i Signature Signa re - Signature Nf 24 hr 49 hr sday II Report(includes DUP,MS <br /> X Standard(-10.15 wmkuW days) MSD,as required,may be <br /> ed Name Printed Nam l ✓ Pnrlttd Nance Printed Name Provide Verbal Prdnomary Results charged as samples) <br /> Tim R Wright Prmade FAX PrehminaryResults III Data Validation Report <br /> Firm 17 /� ��O Finn Requested Repml Dale (includes All Raw Data) <br /> IT Corporation, �`��r _ RWQCB <br /> Date! rums Ir o#%. 17,CU DatelTime DatwTime ]DatetTtme MA& r d (MD1,s/PQL.VTRACE#) <br /> RELINQUISHED SV RECEIVED BY Special Irlatrvetio»s/Cotaunenta cft; ! T� Container Types Key <br /> r T 40 mi VOA 1 <br /> Signature Signature /X +3�Z-`0�� 250 ml LPE 2 <br /> 500 ml LPE 3 <br /> Premed Name Pontis! Jame <br /> _ l liter HDPE 4 <br /> 500 ml glass 5 <br /> Finn Frust J7 ��G. ��'�� I liter glass 6 <br /> 2x6 sJa ring 7 <br /> FD <br /> -;7 Date I ime tedlar bag a <br />