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r rr 4r �w rr rr rrr �r rr 0-r tr r� �■r rr �r � r� <br /> CHAIN OF CUSTODY/ LASORAT Y ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc. Purchase Order #3648 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab STL!Quhnterra,W.Saito <br /> Project Name Don Rodgers Anal sls Requested <br /> GIohalID T0607700717 r <br /> Project Number 8800391A/01010000 <br /> Project Manager Dan Wynne <br /> Company SHAW Environmental&Infrastructure,Inc. o <br /> Address 1326 North Market Boulevard �°y w <br /> tn <br /> Sacramento,CA 95834 c F <br /> Dir Ph 916-565-4184 ! AX 916-56 356 O° <br /> Sampler's Signature ° F, REMARKS <br /> Sample LAB Sample ,"-t 1 Contamer Types <br /> ID Date Time ID Matrix HCt t Preservations <br /> MW-1R water 3 . 3 <br /> MW-2R p�0 water 3 3 <br /> MW-3R water 3 3 <br /> MW4RS water 3 3 <br /> MW4RD water 3 1 3 <br /> VW-ID -water 3 3 I <br /> VW-2D water 3 3 <br /> VW-3D °` /bpi water 3 3 <br /> VW4 tOvi I I water 3 3 <br /> REL UISHED 7 RECEIVEP BY ffLINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> jPd <br /> Si Signature Signature 24 hr 43 hr 5 day II Report(Includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> amiML Prmte_A Names e ��� Printed Name Pnnttd Name Pt*ide Verbal 4imfnary,Results charged as samples) + <br /> &�- Pro+;de FAX PreliminaryResule III Data Validation Repart <br /> Fi Firm Firm Firm RequesteZl Report Date (includes All Raw Data) <br /> S`SZrSr4C RWQCB <br /> Date/Timer-9-6i-- Date/Time 1 Date/Time Date/Time (MDLs/PQLVrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special instructions/Comments ConrainerTypes Key <br /> 40 ml VOA I <br /> Signature Signature STL 1 Quanterra 125 mf LPE 2 <br /> Need EDDs for GeoTracker 880 Riverside Parkway 500 ml LPE 3 <br /> Pnnted Name Printed Name Report to the P M In PDF format,please W Sacto,Calif 45604 1 liter HDPE 4 <br /> Dan Wynne@shaw=cons - 416-373-5600/Fx 372-1054 500 ml glass 5 <br /> Firm <br /> Firm Contact Jon Gildersleeve I Etter&ss 6 <br /> 2x6 s/s ring 7 <br /> Datefrime Date/Time Field Coord Shetla P16-565-4327 glass jai' 8 <br /> .aa <br />