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r. �r rr ■r 0-r r rr r M M M r 0-r r sf <br /> CHAIN OF CUSTODY/LABORAT ANALYSIS REQUEST FORM <br /> Q <br /> SHAW Environmental& Infrastructure,Inc. Purchase Order <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab STL I Quanterra,W Sacto <br /> Project Name Don Rodgers Anal sis Requested <br /> GlobalID T0607700717 <br /> Project Number 8800391A/01010000 y <br /> Project Manager David Herzog <br /> Company SHAW Environmental& Infrastructure,Inc N <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 0 0 <br /> Dir Ph 916-565-4377 / F 916-56 4356 v ?� <br /> Sampler's Signature w <br /> z H m REMARKS <br /> Sample LAB Sample - 1 Container Types <br /> I D Date Time I D Matnx HCl Preservations <br /> MW-1R XI-3 XI-3 84A water 3 3 <br /> MW-3R ll water 3 3 <br /> M W-4RS 1033 water 3 3 <br /> MW-4RD �e,,�t' water 3 3 <br /> VW-213 water 3 3 <br /> VW-313 water 3 3 <br /> VW-4 00g U water 3 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sign Slgn Signature Signature 24 hr 49 hr 5 day lI Report(includes DUP,MS <br /> X standard(-10-15 working days) MSD,as required,may be <br /> Pri ame Prin ed Name Printed Name Printed Name Pf de Verbal Preliminary Rauh charged as samples) <br /> AL. PrcmdeFAX Preliminary R=ltt III Data Validation Report <br /> Firm` Firm S1, Firm Firm Requested ltepon Date R (includes All Raw Data) <br /> Date/Time /1&03 Datefrime [t(d \r)O Date/Time Date/Time (MDLs/PQLs/PRACE#) <br /> RELMUISHED BY RECE D BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature STL/Quanterra 125 ml LPE 2 <br /> Need EDDs for GeoTracker 980 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Printed Name Report to the P M in PDF format,please W Sacto,Calif 95604 1 liter HDPE 4 <br /> David Herzog@Shawgrp com> 916-373-5600/Fc 372-1059 X00 in)glass 5 <br /> Firm Firm Contact Jon Gildersleeve Iliter glass 6 <br /> 2x6 s/s ring 7 <br /> Datc/Tirre DatelTime Shaw sample coord Sheila'@ 916-565-4327 glass jar 8 <br />