Laserfiche WebLink
CHAIN OF CUSTODY 1 LABORATOY ANALYSIS REQUEST FORM <br /> IT CORPOSON- 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order <br /> 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 880-040.1A/01060000 _ <br /> Project Manager Kathleen Waldo 0 <br /> Company IT CORPORATION I~ <br /> Address 1326 North Market Boulevard 5 c $ <br /> Sacramento,CA 95834 0 °�° W 121 1 <br /> Phone (916)928-3300 U X W <br /> FAX (916)928-3341 ° pq A <br /> Sampler's Signature ' W <br /> REMARKS <br /> amp a amp e 1 Container Types <br /> I D ate Time I D Matrix HCl <br /> Preservations <br /> MW-1 T A61 Water 5 5 <br /> MW-2 30 Water 5 5 <br /> MW-3 Water 5 5 <br /> RE[INQUISHED BY RECEIVED BY RELINQUISHED BY <br /> Q RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> Si aur a <br /> REQUIREMENTS X I Routine Report <br /> Si a <br /> Signature 24 lir 48 hr 5 day II Report(includes DUP,MS <br /> Prim d ani d eSundsrd(-10.15 working-days) MSD,as required,may be <br /> Y ���� �nnted Name Printed Name Provide Verba!Preliminuy Results charged as samples} <br /> ocAe I nrni r Firm Fig Provide FAX Preliminary Raulu III Data Validation Repari <br /> l Requ'!ed Diak (includes All Raw Data) <br /> 11JILf(']i!!l t_ <br /> DatclT]me Z 1 Date/Time RWQCB <br /> Date/Time (MD[s1PQI.sfI RACbt+} <br /> RF I INQUIS IIF D BY RECEIVED BY Special Insiruclions/Comments <br /> Container Types Key <br /> SignalurL Signature Sequoia Analytical 250 ml PE 2 <br /> 819 Striker Avenue,Suite 8 500 ml LPE 3 <br /> Printed N41111, Panted Name Sacto,Ca 95934 I liter I IDPE 4 <br /> h <br /> Firm Firm 916-921-96001 Fx 921-0100 500 ml glass 5 <br /> Contact Ron Bobel I liter glass 6 <br /> i),ltL/1 m]c. Date/Time <br /> 20 s/s ring 7 <br /> giass)ar S <br />