Laserfiche WebLink
1 M <br /> CHAIN OF CUSTODY /LABORA Y ANALYSIS REQUEST FORM <br /> IT CORPORATION-1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order <br /> {916}928-3300 FAX(916)928-3341 Lab Sequoia Analytical,Sacta <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Project Number 880-0401A/01060000 <br /> Project Manager Mike Sgourakis N <br /> Company IT CORPORATION W <br /> Address 1326 North Market Boulevard g o o <br /> Sacramento,CA 95834 0 � W <br /> Dir Ph (916)565-4369 / FAX 916)928-3341 V X <br /> I ¢ <br /> � A F <br /> Sampler's Signature a W <br /> C7 <br /> x <br /> SREMARKS <br /> SP a LAB Sample 1 J,# I Container Types <br /> I D Da Tune ID Matrix ►� k HC! <br /> MW-1 OWL Water 5 5 Preservations <br /> MW-2 Water 5 5 <br /> MW-3 3 Water 5 5 <br /> I <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED$Y RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> 5i t S1 lure Signature g Signature 24 hr 48 hr s day II Report(includes DUP,MS <br /> Pante ame Panted Name%4� T f I 1.^f) (."/() -Stsndud(-10.15 working days) MSD,as required,may be <br /> PrirHed f 4p-cf r5 Panted Name Pmndc Vab�P-prrehm�nsry Apults charged as samples) <br /> Fl>/m�rn Vx n Fi �--I I Firm Provide FAX PrehminuyRMIts III Data Validation Report <br /> Fig Re'«ted Repnil his (includes All Raw Data) <br /> ora <br /> Date/Time Q Date/T e tRWQCB <br /> t),'Z l Date/rime Date/Time <br /> RELINQUfSHED BY RECEIVED BYSpecial Instructions/Comments (MDLs/PQLs/I'RACE#) <br /> Container Types Key <br /> Signature 40 ml VOA I <br /> g Signature Need EDDs as required by the RWQCB Sequoia Analytical 250 ml LPE 2 <br /> Printed Name Printed Name 819 Striker Avenue,Suite S 500 ml LPE 3 <br /> Sacto,Ca 95834 1 liter HDPE 4 <br /> Firm Firm <br /> 916-921-9600/Fx 92I-0100 500 ml glass 5 <br /> Contact Ron Chew 1 liter glass 6 <br /> DatelTime Date/Time 20 sls ring 7 <br /> I �` glasp jer 8 i <br />