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CHAIN OF CUSTODY 1 LABORATOY ANALYSIS REQUEST FORM <br /> IT CORPO ION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 164066 <br /> 0 <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical,Sacto <br /> Project Name Parkinson's Arco,Stockton Analysts Requested <br /> Protect Number 880-0401A/01060000 <br /> Project Manager Kathleen Waldo Q <br /> Company IT CORPORATION ir w <br /> Address 1326 North Market Boulevard . o P N <br /> Sacramento,CA 95834 0 <br /> Phone (916)928-3300 U Q <br /> FAX (916)928-3341 ° A <br /> Sampler's Signature W <br /> REMARKS <br /> Sample LAB Sample P 1 Container Types <br /> ID D to Time ID Matrix 1 , HCl Preservations <br /> MW-1 t Water 5 5 3 f <br /> MW-2 Water 5 5 <br /> MW-3 Water 5 5 <br /> RELINQUISIIED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sign r Sm <br /> Signature Signature u hr +e hr 5 day H Report(includes DUP,MS al-1- rx aag) <br /> Sdard(-10.15 v mrking days) MSD,as required,may be <br /> Pn arPe( Printed N e Printed Name Printed Name Proviunde Verbal Prehmmsry Results charged as samples) <br /> — Provide FAX Preliminary Results llt Data Validation Report <br /> Firp� F)qn Finn Firm R�,«1ed Repan Date (includes All Raw Data) <br /> \+[r' RWQCB <br /> Date/Time Date/P1 a q t Date/Time Date/Time (MDI MLs/TRACE#) <br /> RE[INQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA i <br /> Signature Signature Sequoia Analytical 250 ml LPE 2 <br /> U 819 Striker Avenue,Suite 6 500 ml LPE 3 <br /> Printed Name Printed Name Q Sacto,Ca 95834 1 liter HDPE 4 <br /> 916-921-96001 Fx 921-0100 500 ml glass 5 <br /> Firm Firm Contact Ron Bobel 1 liter glass 6 <br /> 2x6 sls ring 7 <br /> DatcCTnnc Dale/Time glass jar 8 <br />