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4P CHAIN OF CUSTODY /LABORAT010ANALYSIS REQUEST FORM <br /> IT CORPORATION- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 164066 <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia AnaE tical,Sacto <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Project Number 880-040.1A/01060000 <br /> Project Manager Kathleen Waldo c <br /> Company IT CORPORATION pwpq� <br /> Address 1316 North Market Boulevard <br /> Sacramento,CA 95834 0 <br /> Phone (916)928-3300 4&4 d <br /> FAX (916)928-3341 C A <br /> Sampler's Signature wq. <br /> REMARKS <br /> Sample LAB Sample lContainer Types <br /> ID Date Time ID Matrix HCI JPreservations <br /> MW-1 Water 5 5 3} <br /> MW-2 Water 5 5 <br /> MW-3 Water 5 5 <br /> s <br /> RELIN ISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signa r tune Signature Signature 24 lir 48 1w s day Il Report(includes DUP,MS <br /> ..J L'ousnedard(oats anrkme days) MSD,as required,may be <br /> Prm Warn Printed IAirria Printed Name Printed Name Provide verbal Preliminary ttmuia charged as samples) <br /> n Provide FAX PrelimiamyReaul4 Ill Data Validation Report <br /> Firm F Firm Firm Requested Report nate (includes All Raw Data) <br /> rdm _RWQCB <br /> Date/rime DateffirW IL161tol_ tlr„ DataMme jDataMme (MDLMLsrrRACE#) <br /> RELINQUISHE BY RECEIVED BY Special histructionslComments !� Container Types Key <br /> 40 ml VOA I <br /> Signature Signature Need EDDs as required by the RWQCB n r� Sequoia Analytical 250 ml LPE 2 <br /> t�Dc}J 849 Striker Avenue,Suite 8 500 all LPE 3 <br /> Printed Name Printed Name �aeto,Ca 95834 1 liter HDPE 4 <br /> 916-921-96001 FX 921-0100 500 ml glass 5 <br /> Firm Firm Contact Ron Chew 1 liter glass 6 <br /> 2x6 sls ring 7 <br /> Dateltrme Datellime glassJar 8 <br />