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CHAIN OF CUSTODY!LABORATORY ANALYSIS REQUEST FORM <br /> -4 SHAW Environmental&Infrastructure,Inc. I Purchase Order.1326 North Market Boulevard Sacramento CA 95834 Il Lab STLI uanterr11 W.Sacto <br /> Project Name:Dorn Rodgers Anal szs Requested <br /> Global ID: 70607700717 <br /> Project Number 8800391A/01010000 ' <br /> Project Manager David Herzog lily <br /> Company SHAW Environmental&Infrastructure,Inc. <br /> Address 1326 North Market Boulevard 0 w <br /> Sacramento,CA 95834 w NQ — 3 <br /> Dir Ph 916-565-4377 1 F 916»56 356 � G � <br /> Sampler's Stgnature Z IN REMARKS <br /> Sample LAB Sample III Coiitamer <br /> Types <br /> I D Date Time ID Matrix HCI <br /> Preservations <br /> MW-1R t1- 8`N water 3 113 <br /> I! <br /> MW-3R water 3 II3 <br /> MW-4RS \tom water 3 1�3 1 <br /> MW-4RD \011 water 3 I�3 <br /> 0 <br /> VW-2D X38 water 3 1'3 1 <br /> 4 VW-3D \QZ water 3 N 11 <br /> $ VW-4 water 31 '3 <br /> II 1l <br /> RELINQUISHED BY RECEIVED BY RELINQUISHEDB II � RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREKENE'S X I Rotitine Report <br /> Sign Signatu Signature II 1 Signature 24 hr —4s hr s d y it Report(includes DUP,MS <br /> X Sucid rd(-tats worms dm) MSD,as required,may be <br /> PmW Name Printed Nmue ` Printed Name Provide VaW Prehrnmay Rendta charged as samples) <br /> % f Pi PdtFAX PM=nuy?Wu1 s III Data Validation Report <br /> Firm <br /> BMW I Firm �I Firm Re"atedPep-D- (includesAll Raw Data) <br /> RwQCB <br /> DaWrime i-4,03 Date rime It 6 jfyo Datef ime d II Date/Fime (N[DLslPQLsRRACE#) <br /> RELINQUISfMD BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> Signature Signature 40 ml VOA 1STL/Quanterra 125 ml LPE 2 <br /> Need EDDs for GeoTracker 880 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Printed Naive Report to the P.M iii I r format,please W Sacto,Calif 95604 1 liter HDPE 4 <br /> <David.Henog(Shawgrp com> 916- 313-56001 Fx 372-1059 500 rnl glass 5 <br /> Firm Firm I � Contact Jon Cildcrsleevc I lacr plass 6 1 <br /> I 1 2,,6 s/s ring 7 <br /> DawTirre Daterrime Shaw saniplc word Sheila 916-5654327 glasslar g <br /> A <br />