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CHAIN OF CUSTODY / LABORATIt`'Y ANALYSIS REQUEST FORM <br /> IT CORPORCJN- 1433 North Market Boulevard,Sacramento,CA 95834 L Purchase Order: <br /> (916)928-3300 FAX(916)928-3341 Lab: Sequoia Analytical <br /> Project Name: Parkinson's Arco,Stockton Analysis Requested <br /> Project Number: 880-040.IA/01050000 <br /> Project Manager: Kathleen Waldo 0 <br /> Company: IT CORPORATION W <br /> Address: 1433 North Market Boulevard o <br /> Sacramento,CA 95834 <br /> Phone: (916)928-3300 4. <br /> FAX: (916)928-3341 ° A <br /> Sampler's Signature: w <br /> REMARKS <br /> Container Types <br /> Sample LAB Sample ,, 1 Preservations <br /> LD. Datj Time I.D. Matrix t? IICI <br /> MW-1 Water 5 1 5 <br /> MW-2 PIT Water 5 5 <br /> r <br /> MW-3 Water 5 5 <br /> s <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIRENIENTS X 1. Routine Report <br /> Sign reSimstore Signature Signature 24 hr re hr s day It, Report(includes DUP,MS <br /> stauda d(-10-15 working days) MSD,as required,may be <br /> Pri d arae Pri d e Printed Name Printed Name Provide verbal Preliminary Results charged as samples) <br /> Provide FAXPrelimiauy Results ill.Data Validation Report <br /> FirmC' i Firm Firm Requested Report Date: (includes All Raw Data) <br /> IT- RWQCB <br /> Dalefrime b - Datelri Date/Time Datefrime (MDLsIPQI.sfl-RACE#) <br /> REI.I Ql 1S1 D BY RECEIVED BY Special InslructionslCommenls: Container Types Key: <br /> nil VOA: I <br /> Signature Signature Sequoia Analytical 250 nil LPE: 2 <br /> 819 Striker Avenue,Suite 8 500 ml LPI: 3 <br /> Printed Name Printed Name Sacto,Ca 95834 1 liter IIDPE: 4 <br /> 916-921-9600 1 Fx:921-0100 500 ml glass: 5 <br /> Firm Firm Contact:Ron BoW 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Dalefrinic Pate/Time glass jar: 8 <br />