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_ w _ CHAIN OF CUSTODY / LABORATVY ANALYSIS REQUEST OR <br /> IT CORPOROON- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 165908 • - <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical, Sacto <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01050000 <br /> Project Manager Tim Anenson N <br /> Company IT CORPORATION � oa <br /> Address 1326 North Market Boulevard v' <br /> Sacramento,CA 95834 U 00 <br /> Phone 916-928-3300 <br /> FAX 916-928-3341 <br /> Sampler's Signature t7 w <br /> x <br /> REMARKS <br /> Sample LAB Sample lContainer Typ,-s <br /> I D Pate, Time ID Matrix HCI Preservations <br /> M W-1 R 67DO water 3 3 <br /> VW-2 D (Q water 3 3 <br /> VW-3 f) water 3 3 <br /> RE[INQUISfIED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Stgnpt r St at Signature Signature 24 hr 49 hr s day II Repon(includes DUP MS <br /> S.dud(-I0MSD,as required,may be <br /> Pn t d ant Prin N e Pnnted Name Printed Name Provide Verba[Prehmtnary Results charged as samples) <br /> , 0V a� �� � Provide FAX Preliminary Results III Data Validation Report <br /> 1 irm Vry Ft Firm Firm Requested Report Date (includes All Raw Data) <br /> l RWQCD <br /> Datcfl tnt� j Datcri'i aDate/Ttme DatwTune (MDI s1PQ1 sfl RACFII) <br /> Iti I [Not 1611 t l)BY RE(LIVLD BY Special Inslructions/Comments Sequoia AnalytiLdl Coutaint,r f ypt.s is cy <br /> 819 Striker Ave,Ste 8 40 nit VOA I <br /> Signalun Signature Sacramento,Ca 95834 125 nil l PL 2 <br /> 916 921-9600 500 iiii f PE 3 <br /> Prrtitt,d Nat]it. Printed Name Contact Ron Che%v I Ilter I IDPE 4 <br /> 500 nil glass 5 I <br /> k unt I irm I Iim glass 6 <br /> 2xh sls ring 7 <br /> l3,il��ltni� DaltlTunc glass lar 8 <br />