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;> Lr ii t ;� � '€'v► ANALYSIS REQUEST FORM <br /> IT CORPORA 'Y- 14333 North Market Boulevard,Sacramento,CA 95834 r <br /> (916)928-3300 rAX(916)928-3341 Purchase Order: <br /> Project Name: Parkinson's Arco,Stockton Lab: Sequoia Analytical - <br /> Project Number: 880-040.IA/01050000 Analysis Requested <br /> Project Manager: Kathleen Waldorq <br /> 0 <br /> Company: IT CORPORATION 040 <br /> Address: 1433 North Market Boulevard r <br /> 0 <br /> o � <br /> Sacramento,CA 95834 <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 a <br /> Ara A <br /> Sampler's Signature: <br /> Samp eLA REMARKS <br /> I U• Dat Time l.D. Matrix IiCI Container Types <br /> M W-i Preservations <br /> ( t 3 Water 5 5 Z <br /> MW-2 �r Water 5 5 <br /> MW-3 Water 5 5 <br /> EE <br /> REI.IIVQIJISIIED BY RECEIVED BY RELINQUISHED BY <br /> RECEIVED BY TUFERNAROUNb REPORT REQU117EMENTS• <br /> EFF 4 <br /> Sign ]re ature Signature REQUIREMENTS X 1. Routine Report <br /> Signature 24 hr 48 hr 5 day 11. Report(includes DUP,MS <br /> Priu d anis Pri ed '—Printed Name Printed Name <br /> a standard(-10.15 working days) MSD,as required,may be <br /> Provide Verbal Preliminary Results charged as samples) <br /> Firm 1 irniProvide FAX PeeliminaryResulrs Ill.Datil Validation Report <br /> 1'lfnt Requested Report Dare: <br /> � U�� (includes Al]Raw Data) <br /> DatefFinic r (} DatelfiRWQCB <br /> REL I QI ISII I)IIl' Datellime [7atefTinie <br /> RECEIV'D BY Special Instruetians/Cnmments: (HDLs/PQlsf1'RACE+Y) <br /> Container Types Key: <br /> tu <br /> Signare r,, <br /> Signature '` V, 40 nil VOA: <br /> Sequoia Analytical 250 nil LPI:: 2 <br /> Printed Naive Printed Name 819 Striker Avenue,Suite S 500 nil LPE: 3 <br /> Sacto,Ca 95834 1 liter IIDI'E: 4 <br /> Firm Firm 916-921-96001 Fx:921-0100 500 nd glass: 5 <br /> Contact:Ron Bobel 1 liner glass: 6 <br /> Datell imc Datcfl imc 2x6 s/s ring: 7 <br /> ' glass jar. 8 <br />