Laserfiche WebLink
CHAIN OF CUSTODY 1 LABORATOW ANALYSIS REQUEST FORM <br /> IT CORPORAN- 1433 North Market Boulevard,Sacramento,CA 95834 Purchase Order <br /> (916)928-3300 FAX(916)928-3341 Lab Sequoia Analytical <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> ProjectNumber 880-040.1A/01050000 0 <br /> Project Managei Kathleen Waldo o N <br /> Company IT C ORPORATION <br /> Address 1433 North Market Boulevard o <br /> Sacramento,CA 95834 " a <br /> Phone (916)928-3300 w oao w _ <br /> FAX {916}928-3341 <br /> Samplers Signature <br /> x REMARKS <br /> Sample LAB Sample l Container Types <br /> I D Date Time I D Matrix HCI Preservations <br /> MW-1 OM Water 9 1 9 <br /> MW-2 6 Water 9 9 <br /> MW-3 p1Z- Water 9 9 <br /> RELINQUIS!{t}D�t EIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> SI turf ` _ at Signature Signature 24 hr 48 bt say 11 Report(includes DUP,MS <br /> MI.- )� sra�& t-10.15 wwktoa day,) MSD,as required,may be <br /> Printed Name Ppoed Name Printed Name Printed Name Powe VoU Pretimuuuy iteruip charged as samples) <br /> Prude FAX Prelimvury Rnalss III Data Validation Report <br /> Firm <br /> lDat *nn <br /> Firm Finn it"u wd Rq—nam (includes All Raw Data) <br /> ? ice_ RWQCB <br /> Date/time Dateftw (MDLs/PQIs/iRACE#) <br /> RELINQUISI IED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature Signature Sequoia Analytical 250 ml LPE 2 <br /> 819 Striker Avenue,Suue 8 500 ml LPE 3 <br /> Printed Name Printed Name Sacto,Ca 95834 1 liter I IDPE 4 <br /> 916-921-9600/Fx 9210 100 500 m1 glass 5 <br /> Firm Finn Contact Sand or Ron I liter glass 6 <br /> 2x6 s!0.ring 7 <br /> Datcll line Date/time , Jt glass Jar 8 <br />