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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM ' Page L of <br /> IT CORPORATION-1326 North Market Boulevard,Sacramento,CA 95834 PO Number: <br /> (916)928-3300 FAX L919 928-3341 Lab: Se uoia <br /> Project Name: Harney Lane Landfill,San Joaquin County Anal 's Requested <br /> Project Number: 791290 <br /> Project Manager: Steve Giacomini N <br /> Company: IT CORPORATION $ <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 o W <br /> u <br /> Phone: (916)928-3300 w c <br /> FAX: (916)928-3341 o <br /> - o <br /> Sampler's Signature: C <br /> A REMARKS <br /> Sampic LAB Sample t 1 container Types <br /> 1.D. Date Time I.D. Matrix HCl N 1 Preservations <br /> Ni W-2 water 4 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINNUISHED BY RECEIVED TURNAROUND REPORT REQUIREkIENTS <br /> AREQUIREMENTS 1. Routine Report <br /> Signal a Signature Si ure. Si <br /> J to, i", -7 6e`�'�, error aanr sasy If. Report{incluAcs D1 11',MS <br /> ___�ftL t�"ar'�-'` X, Slautud(-10-Is wo"ig days) MSD,as required,may be <br /> Prinwfamc is Printed N Prirge� Arno Printed Namo Provide VaW Pidunbury Results charged as samples) <br /> VL �G,A i dj -47Provi&FAX Pretinmwyxesutu X Ill.Data Validation Report <br /> Finn Mtrm ( Ci �" l u�/� r I� FPgtl O� Requested Rein[ru: (includes All Raw Data) <br /> _— `/ '1 Q1 to— X RWOCD <br /> Dat4rrime c '4e-'l Daterrime Date rime Datefrime (MDts/PQWrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special InsimcUons/Conmients: Container Types Key: <br /> Sequoia Analytical 40 nil VOA: I <br /> Signature Signature 819 Striker Avenue,Ste,3 250 ml LPE: 2 <br /> Report MDI.PQL and Tram Sacramento,Ca 95934 500 ml LPE: 3 <br /> Printed Name Printed Num Report requested amlyta only• 916-921-9600 1 liter HDPE: .4 <br /> 500 ml glass: 3 <br /> Finn Finn 1 liter glass: b . <br /> 2a6 s/s ring: 7 <br /> I)atcll'uno Datelflrrle . <br /> glass jar. 8 <br />