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mmmmmmmmm mmmmmmm4rm <br /> 0 CHAIN OF CUSTODY/ LABORA RY ANALYSIS REQUEST FORM <br /> IT CORPORATION-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 Analysts Requested <br /> Project Number 880039.IA/01050000 <br /> Project Manager Mike Sgourakis N <br /> Company IT CORPORATION L4o <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 U 00 <br /> Phone 916-928-3300 x <br /> FAX 916-928-3341 c <br /> Sampler's Signature 0 w <br /> REMARKS <br /> amp e LAB Sample I Container Types <br /> I D Date Time I D Matrix 4. HCl Preservations <br /> MW-111 t1Cb I Ilif- "OZ- water 3 3 <br /> VW-2 a%,-,z 11,1j l`>f 29 water 3 3 <br /> VW-3 OX3 II-/1" I YS/ water 3 3 <br /> RELINQUISHED BY RCfIVJD BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> Signatu ignature Signature Signature 24 hr 49 hr s day 11 Report(Includes DUP,MS <br /> Suedard(-10 15.kmg day.) MSD,as required,may be <br /> Prin FrlfitEd Name Printed Name Printed Name Pmvnde verbal PWimWvy naulu chargcd as samples) <br /> uL ll.t�y„ if l Pm ids FAX PM1minvy Rauh III Data Validation Report <br /> Firm Firm Firm Firm RaquarwRgWDNO (includes All Raw Data) <br /> dxp 1i�- RWQCB <br /> Datelfime I D i c DaWrime Date/fame (MDLs/PQLs-fRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Iustructions/Cominents• Sequoia Analytical Container Types Key <br /> 819 Striker Ave,Ste 8 40 ml VOA 1 <br /> Signature Signature Sacramento,Ca 95834 125 ml LPE 2 <br /> 916-921-9600 500 ml LPE 3 <br /> Printed Name Printed Name Need EDDs per RWQCB Requirement Iqr U$T sites. Contact Ron Chew I Ilter HDPE 4 <br /> $00 ml glass S <br /> Firm Firm I liter glass 6 <br /> 2x6 sls ring 7 <br /> n - rr In'tf-FrImi. glass jar 8 <br />