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i i i i i ii i i i i i i i i <br /> CHAIN OF CUSTODY 1 LABORATO=ANALYSIS REQUEST FORM <br /> Shaw E&I Inc. - 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order # 189246 for 02' <br /> Lab Spar er Technolo <br /> Project Name Don Rogers D Analysis Re uested <br /> Project Number 880039 1A/01030000 <br /> Project Manager David Herzog o <br /> Company `J�1u►tic E> Z,Z hC C °�,,,° <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 U <br /> Phone 916-565-001 F 916- 5-4356 0 <br /> Sampler's Signature Z REMARKS <br /> Container Types <br /> Sample LAB Sample 1 <br /> Preservations <br /> ID Date Time ID Matrix Tedlar <br /> Infl Air 1 1 <br /> ERI Air 1 I <br /> TURNAROUND REPORT REQUIREMENTS <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY <br /> REQUIREMENTS X I Routine Report <br /> Signature 24 hr 48 hi 5&y I1 Report(includes DUP,MS <br /> Sign r Sl24ME��Prtnted <br /> Signature X Standard(--ill 15 working days) MSD,as required,may be <br /> rated Name Printed Name Name Printed Name Promde Verbal Prehrrunaiy Results charged as samples) <br /> R Wright �/L Provide FAX Prehminary Results III Data Validation Report <br /> Tun Tun Finn Finn Requested Report Dale (includes All Raw Data) <br /> Firm <br /> Shaw E&I Inc. Fif 1 + �"� RWQCB — <br /> Date/Time p <br /> DatefTim2: S fsr— Date/Time — Daterrime — — (MDLsIPQLsITRACE4) <br /> RELINQUI HED BY RECEIVED BY Special InstructlonslComments Container Types Key <br /> 40 ml VOA 1 <br /> 125 nil LPE 2 <br /> Signature <br /> Signature 500 ml LPE 3 <br /> Sparger Tech <br /> 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> Primed Name Printed Name <br /> Sacto,Calif 45827 500 ml glass 5 <br /> 916 362 8947/Fx 362-0947 1 liter glass 6 <br /> Firm Firm <br /> 2i.6 s!s ring 7 <br /> Date/Time Date/Time glass1ar 8 <br />