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CHAIN OF CUSTODY 1 LABORAT ANALYSIS REQUEST FORM <br /> IT CORPORr. ON- 1326 North Market Boulevard,Sacramento,CA 958340 <br /> Purchase Order 1164066 <br /> {916}928-3300 FAX(916)928-3341 <br /> Project Name Parkinson's Arco,Stockton Lab Sequoia Analytical,Sacto <br /> Project Number 880-040 IA/01060000 Analysts Requested <br /> Project Manager Kathleen Waldo a <br /> Company IT CORPORATION j <br /> Address 1326 North Market Boulevard ~ pq e] <br /> H � <br /> Sacramento,CA 95834 a °� w <br /> Phone (916)928-3300 U <br /> FAX (916)928-3341 <br /> cA A <br /> Sampler's Signature <br /> x <br /> SampleI LAB e v, I REMARKS <br /> I D ate Time ID Matrix HCI Container Types <br /> ,�a <br /> Preservations <br /> MW-1 Q ✓�f Water 5 5 1I <br /> MW-2 ?jo Water 5 5 <br /> M W-3 Water 5 5 .4— . - --- <br /> w <br /> r <br /> RE[1NQl11SIIkD BY RECEIVED BYRELINQUISHED BY <br /> RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> 411riii;Zd <br /> ur� a Si natwv <br /> Signature 24 hr as hr 5 day II Report(includes DIJP,MS <br /> °°t d e anted Name SMSD,as required,may be <br /> Printed Name Provide Verbal Prelrmrnary Results <br /> charged as samples) <br /> E Ifni r t P'lr + t Firm FProvide FAX Prebminary Results Ill Data Validation Report <br /> ig <br /> Requested Rgvn Date (includes All Raw Data) <br /> 11116fl muC7(2,111)1RW" <br /> Daterfimet patt./I'ime Date/time <br /> REI 1N IlI HH D BY (MDI s/PQLsfi RACEN) <br /> Q RECEIVED BY Special Inslructions/Comments Container Types key <br /> Slgndturt. Signature 40 H VOA I <br /> Sequoia Analytical 250 mi I P£ 2 <br /> I'nnk.d NdI11L Prinlld Name ` 819 Striker Avenue,Suite 8 500 ml LPE 3 <br /> Saeto,Ca 95834 1 liter HDPE 4 <br /> 1 <br /> 916-921-96001 Fx 921-0100 500 ml glass 5 um Firm Contact Ron Bobel <br /> 1 IltLf glass 6 <br /> 1 I�Il ilni, Ddl�/1 ime 20 s/s ring 7 <br /> glass jar 8 <br />