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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc. <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 208456 <br /> Project Name Don Rogers Lab SiAnal cal � <br /> Project Number 8800391A/01020000 �� sts Requested erra <br /> Project Manager David Herzog N <br /> Company SHAW Environmental&Infrastructure,Inc. G <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 U00 <br /> Phone 916-565-4377/ FAX 916-565-4356 c W <br /> E- <br /> Sampler's Signature .o <br /> Sample z REMARKS <br /> P LAB Sample II 1 {f <br /> i D Date Tune ID Matrix II Tedlar Container Types <br /> Preservahons <br /> INTEL Vapor 1 II 1 II <br /> EFFL Vapor 1 II III <br /> II II <br /> II I[ <br /> II �I <br /> II II <br /> II II <br /> I II II <br /> II II <br /> II II <br /> REL J1PSjIED BY RECEIVED BY RELINQUISHED'BY [ RECEIVED BY TURNAROUND REPORT REQI3IREMENTS <br /> f REQUIREMENTS X I Routine Report <br /> natyre _ Signature SignatureI � Signature 24 hr 48 hr 5 day II Report(includes DUP,MS <br /> X Standard(-10.15 working days) MSD,as required,may be <br /> Printed Name �' Printed Name Printed Name I V Printed Name Provide Verbal Prehmr <br /> Tim R Wright ` �'ala charged as samples) <br /> Pro"&FAX Prehmmary Results III Data Validation Report <br /> Firm Finn FirmFirm Requested Report Dare <br /> Shaw E&I Inc II (includes All Raw Data) <br /> Date/Time RWQCB <br /> eime Date/Time <br /> Date/Time (MDIs/PQLs(TRACE4) <br /> RELfNQUISHEJD BY RECEIVED BY Specisl Instructions/Comments <br /> I � Container Types Key � <br /> Signature Signature ,,�1 4D ml VOA 1 <br /> \ Sierra Analytical 125 ml LPE 2 <br /> Printed Name <br /> ' M 26052 Merit Circle,Ste 105 500 ml LPE 3 <br /> Pnnted Name V` Laguna Hills Calif 92653 1 11ter HDPE 4 <br /> 949 348-9389/Fx 348-9115 500 ml glass 5 <br /> Fri FtRn J 1�1� Ship Golden State Courier <br /> I Jitet lass 6 <br /> Acct No 14365 $ <br /> Date/Time Date/Time 2x6 s/s ring <br /> 800-322-5555 glass g <br />