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CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM Page_of <br /> IT CORPORATION- 1326 North Market Boulevard,Sacramento,CA 95834 IT P.O. 168151 <br /> (916)928-3300 FAX 916)928-3341 Lab: Sequoia Analytical,Sacto <br /> Project Name:Corral Hollow Landoll,San Joaquin County Analysis Requested <br /> Project Number: 791291 <br /> Project Manager. Steve Giacomini 0 <br /> Company: IT CORPORATION <br /> Address: 1326 North Market Boulevard ® , g <br /> Sacramento,CA 95834 2 <br /> Phone: (916)928-3300 <br /> FAX: (916)928-3341 ® a H N <br /> Sampler's Signature: <br /> 41 °" REMARKS <br /> ample- --S—ample 4A <br /> .� lContaincr Types <br /> I.D. Date Time I.D. Matrix HCI Preservations <br /> MW-4 U/ / water 3 3 ctDI <br /> ll ii <br /> - 4 <br /> �s <br /> a <br /> REI,INQIIISIIED BY IkFREIVED BY (aJ RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signature S' M Signature Signature 24 hr 48 hr 5 day It. Report(includes DUP,MS <br /> S '! `(, cwt Standard(^10.15,vwk7,day.) MSD,as required,may be <br /> Printed NIM Pr ted Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> ,'�(ijn^ Provide FAX Preliminary Results Ill.Data Validation Report <br /> m d Firm Finn Requested Report Date: (Includes All Raw Data) <br /> fir <br /> ill Z:,lut /Yt U D1 i L4 x RWQCB <br /> Date/rime Date/Time DatelTime DatefTime (MDIs/1'Qt /I RACE#) <br /> RELINQUISIIED BY RECEIVED BY Special Instructions/Comments: a <br /> ` - gl <br /> (; Contai r Types Key: <br /> —Sequoiu Analytical 40 ml VOA: I <br /> Sigoaltue Signature 111tase report MDLs,PQIs,and•Trace. 819 Striker Aycnuo,Sulic 8 250 nil LPI;: 2 <br /> please report only analytes requested Sacramento,Ca 95834 500 nil Ll't:: 3 <br /> Printed Name Printed Name 916-921-9600 1 liter HDPE: 4 <br /> 500 ml glass: 5 <br /> Firm Firm 1 liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Dald Chile Dalcll9me glass jar: 8 <br />