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v J � <br /> • CHAIN OF CUSTODY/ LABORATA ANALYSIS REQUEST FORM 0 <br /> IT CORPORATION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order COD IL <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical,Sacto <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Project Number 880-0401A/01060000 <br /> Project Manager Mike Sgourakis o <br /> Company IT CORPORATIONW� <br /> Address 1326 North Market Boulevard o w <br /> Sacramento,CA 95834 0 " <br /> Du Ph (916)565-4369 / FAX 916)928-3341 d <br /> o A <br /> Sampler's Signature C7 W <br /> REMARKS <br /> imp a LAB Sample l Container Types <br /> I 1) 1 Date Time I D Matrix HC1 Preservations <br /> MW-1 Water 5 5 <br /> MW-2 Water 5 5 <br /> MW-3 %3 p Water 5 5 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> 53 t S ture Signature Signature 24 kr 48 hr 5 day 11 Report(includes DUP,MS <br /> X Stsad. (-1415 working days) MSD,as required,may be <br /> Pn d ante arae Printed Name Printed Name Provide Ver6ei Prelrmmary Results charged as samples) <br /> o G e �5 Frm&FAX Prelimmarykeaulta 111 Data Validation Report <br /> FirmFF Fi Firm Firm Requested Report nate (includes All Raw Data) <br /> l ajL RWQCB <br /> Date/Time l d Date/T e '12AOL 1 Dateffime Date'Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instruchons/Com m cuts Container Types Key <br /> 40 ml VOA I <br /> Signature Signature Need EDDs as required by the RWQCB Sequoia Analytical 250 ml LPE 2 <br /> 819 Striker Avenue,Suite 8 500 ml LPE 3 <br /> Printed Name Printed Name i Sacto,Ca 95834 1 liter HDPE 4 <br /> 916-921-96001 Fx 921-0100 500 ml glass 5 <br /> Firm Firm Contact Ron Chew l liter glass 6 <br /> 2x6 s/s rung 7 <br /> Date/Time Date/Time glassjar 8 <br />