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0 CHAIN OF CUSTODY 1 LABORATSY ANALYSIS REQUEST FORM, • v <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 880-0401A/01060000 <br /> Project Manager Kathleen Waldo N <br /> Company IT CORPORATION <br /> w <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 <br /> Phone (916)928-3300 U w <br /> FAX (916)928-3341 ° <br /> Sampler's Signature W <br /> � x <br /> REMARKS <br /> Sample LAB Sample 1 rontamer Types <br /> I D Date Time ID Matrix HCI Preservations <br /> MW-1 /110) V- Water 5 5 <br /> MW-2 851' Water 5 5 <br /> MW-3 B14 Water 5 5 <br /> RELIN ISRED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> Signa rLd lure Signature REQUIREMENTS X 1 Routine Report <br /> A, <br /> 8n Signature u hr 41 hr s day II Report(includes DUP,MS <br /> stead,r7(-10-t5wark; day.) MSD,as required,may be <br /> Print am Prnted�` Printed Name Prmted Name Prowde Verbal PM=hury Rmul4 charged as samples) <br /> 1U, PmvtdeFAX FWnieuyRaWts III Data Validation Report <br /> Firm JFgm Firm Firm Requated deport Date (includes All Raw Data) <br /> �) RWQCB <br /> Date/time IL /.(-)I Daleffirw ( �� (,� Date/time Date/Rine (MDLsIPQLs/fRACI#) <br /> RE[1NQUIS11E BY RECEIVED BY Special Iustructrons/Comments Container Types Key <br /> 40 nil VOA i <br /> Signature Signature Need EDDs as required by the RWQCB Sequoia Analytical 250 ml LPE 2 <br /> $19 Striker Avenue,Suite 9 500 nil I PC 3 <br /> Printed Name Printed Name <br /> 5acto,Ca 95634 I Iver ilflPt: 4 <br /> 916-921-96001 Fx 921-0100 500 ml glass 5 <br /> Finn Firm Contact Ron Chew 1 liter glass 6 <br /> 20 s/s ring 7 <br /> f)aterrime Datc/Time glasslar, g <br />