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I <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br /> IT CORPORATION- 1433 North Market Boulevard,Sacramento,CA 95814 f Purchase Order �Jr <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical <br /> Project Name Parkinson's Arco,Stockton Analysts Requested <br /> Project Number 880-040 IA/01050000ko <br /> ,� e <br /> Project Manager Kathleen Waldo c } <br /> Company IT CORPORATION 00 <br /> Address 1433 North Market Boulevard00 <br /> o <br /> Sacramento,CA 95834 0 in o a0 <br /> Phone (916)928-3300 �t U e A <br /> FAX (916)928-3341 {' ° c�a c w Q <br /> Sampler's Signature ►"" .' C7 W w U <br /> REMARKS <br /> Sample LAB Sample I+ I Container Types <br /> I D Date Time I D Matrix °, III HCl Preservations <br /> MW-1 0q% Water 9 19 Q <br /> MW-2' 10Water 9 I 9 ' <br /> MW-3 Water 9 I 9 <br /> RELINQUISI CEIVED BY �/ ,RELINQUlSiIEb BY I RECEIVED BY TURNAROUND REPOR I REQUIRE111EN'1 S <br /> I� �' r REQUIREMENTS X [ Routine Report <br /> Sl g lurtr Signature Signature l 24 hr 4a hr 5 day 11 Report(includes DUP,MS <br /> rfG- Wr—'leaffnein <br /> i Standard(—Wt5 wurkingdays) MSD,as required,may be <br /> Printed Name P d Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Reaulu 111 Data Validation Report <br /> Firm F Firm Firm Requested Ripon Date (includes All Raw Data) <br /> tit cU I? 7 �� t RWQCB <br /> Date rune DaterI ime DateCrrme Date/Time ' (MIX s/"s/1 RA(I H) <br /> RE[ INQ1IISHED BY RECEIVED BY Special Instructions/Comments ; Contamu TypLs Kt.y <br /> 40 ml VOA 1 <br /> Slgnaturti Signature Sequoia Analytical 250 nil 1 PE 2 <br /> i <br /> 819 Striker Avenue,Sulu,8 500 ml 1 1'L 3 <br /> Pnntt.d Nauu Printed Name Sacto,Ca 95834 1 lrte.r I IDPL 4 <br /> 9t6-921-960011 x 921-0100 500 nil gldss R 5 ` <br /> lirm Furn Contact Sand or Ron I lite glks b <br /> - 2xb sls ring ►` 7 <br /> DatJl mw jDatefrolle �� I glas 8 <br />