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- IMFSi <br /> CHAIN OF CUSTODY I LAEORATuRY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc Purchase Order #3648 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab STL/ uanterra,W Sacto <br /> Project Name Don Rodgers Analysis Requested <br /> Global ID. T0607700717 <br /> Project Number- 8800391A/01010000 <br /> Project Manager Dan Wynne ,� <br /> Company SHAW Environmental&Infrastructure,Inc. o <br /> Address 1326 North Market Boulevard U '� <br /> ua <br /> Sacramento,CA 95834 0 0 <br /> Du'Ph 916-565-4184 / FAX 916-5 -4356 x x <br /> Sampler's Signature I I IREMARKS <br /> Sample LAB Sample I Container Types <br /> I D Date Time i D. Matrix HCI Preservations <br /> MW-IR 8 A-04 u2y� water 3 3 <br /> MW-2R water 3 3 <br /> MW-3R "l water 3 3 <br /> MW-4RS 8ss— water 3 3 <br /> MW-4RD water 3 3 <br /> VW-ID �1i�— water 3 3 <br /> VW-2D 1°l3 water 3 3 <br /> VW-31) 3) water 3 3 <br /> VW-4 lop, water 3 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> St I Signature Signature Signature 24 hr 49 hr 5 day II Report(includes DUP,MS <br /> X stmdazd{�10-15 workL4 chyli MSD,as requRred,may be <br /> Name Panted Name Printed Name Printed Name Provide VaW Prellminuy Results charged as samples) <br /> Ifti— k-or)IAM I Provide FAX Prel=LM Results III Data Validation Report <br /> Firm Firm Firm Firm RequestadRepottDete (includes All Raw Data) <br /> &ta 4.r RWQCB <br /> Datel mie DatelTime DatelTime DatcJT=e �—XDWPQUITRACEP) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments, Contamer Types Key <br /> 40 W VOA I <br /> Signature Swature STL l Quantam 125 ml LPE 2 <br /> Need EDDs for GeoTracker. 680 Rxvensnde Parkway _ SOU ml LPE 3 <br /> Printed Name Printed Name Send directly to: <5usa%waterman@ShaWgrp.00m> W Saco,Calif 95604 1 liter KDPE 4 <br /> 916-373-5600/Fx 372-1059 Soo mi glass 5 <br /> Firm Firm Contact. Ion Gildersleeve I liter glass 6 j <br /> 2x6 sls nng 7 <br /> Date/Time Datell tmc Field Coord Sheila 916-5654327 glass jar 8 <br />