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i CHAIN OF CUSTODY 1 LABORATOY ANALYSIS REQUEST FORM 0 { <br /> IT CORPORATION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 164066 <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical,Sacto _ <br /> Project Name Parkinson's Arco,Stockton Analysts Requested <br /> Project Number 880-040.IA/01060000 <br /> Project Manager Kathleen Waldo c <br /> Company IT CORPORATION , <br /> Address 1326 North Market Boulevard o W $ <br /> Sacramento,CA 95834 ° eO <br /> Phone (916)928-3300 <br /> FAX (916)928-3341 <br /> Sampler's Signature t7 w <br /> REMARKS <br /> Sample L Sample l Container Types <br /> ID D to Time ID Matrix HCI Preservations <br /> MW-1 MIN Um Water 5 5 <br /> MW-2 fit Water 5 5 <br /> MW-3 Water 5 5 <br /> Lt <br /> REI.INQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY 'TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X ( Routine Report <br /> Sign r tort Signature Signetturc <br /> 24 hr +i hr say II Rcpan(includes DUP.MS <br /> siaaard(-10.13 wadkmy day-) MSD,as required,may be <br /> Pri aliel Pnnted N e Printed Name Printed Name Prov*Verbal PrdrmuiM Reaalu charged as samples) <br /> 1y ProvukFAX PrelunmaryRe"is III Data Validation Report <br /> Fi�rOI� F!; Fran Finn Rcquawl Repan Date (includes All Raw Data) <br /> RWQCB <br /> Datelrime Daie/ri y6-1, IL Date/time Date/Time (MDL s/PQi Wl KACW <br /> REI INQUISIILD BY RECEIVED BY Special Instructions/Commetits Container Types Key <br /> 40 nil VOA I <br /> Signature Signature Sequoia Analytical 250 ml I PE 2 <br /> 819 Striker Avenue,Suite 8 500 nit I PE 3 <br /> Printed Nanie Printed Name Sacto,Ca 95834 1 liter ADPL' 4 <br /> 916-921-9600/tx 921-0100 500 gilt glass 5 <br /> 1•irm Firm Contact Ron Bobel r I liter glass 6 <br /> J 2x6 s/s ring 7 <br /> 1 AJI nnL DatriTime glass jar 8 <br />