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CMgN MR--UR%D11RABMA Y MLMS REQUEST FORM <br /> SHAW En menta!& Infrastructure, Inc. 40 - <br /> Purchase Order # 189246 for 2002' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab Sparger Technology � <br /> Project Name Don Rogers Analyses Requested <br /> Project Number 8800391A/01030000 <br /> Project Manager Kathleen Waldo a <br /> Company SHAW Environmental& Infrastructure,Inc v <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 0 <br /> Phone 916-565-4370 / FA916-565-4356 U .. <br /> X <br /> w W <br /> O F^ <br /> L (� <br /> Sampler's Signature A C7 <br /> E _ <br /> 1' <br /> Sample LAB Sample- 1 REMARKS <br /> Types <br /> ID DaV Tune ID Matrix Tedlar Preservations <br /> INFL 7 1 Air I I <br /> EFFL V J(D Air I I <br /> RELINQUISHED BY RE ETVED BY RELIN UISHED BY CEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENT'S X I Routine Report <br /> S° t S ignature, Signature Signa 24 hr 49 hr 5 day II Report(includes DUP,MS <br /> AW standard(-10.15 working days) MSD,as required,may be <br /> ted Nam Printed Name Printed Name anted Name Provide Venal Prelsm omy Results charged as samples) <br /> Pmvrde FAX PreltmmaryResults Iii Data Validation Report <br /> F� r Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> l `a4 �iZd � I f OZ Q Y'z v RWQCB <br /> DatelTime�j a 1 j OV DatelTi a Dat /T me Date/Time (MDLs/PQLs/TRACE#) <br /> RELI Q ISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> Signature Signature 40 ml VOA 1125 ml LPE 2 <br /> Spa ger Tech 500 ml LPE 3 <br /> Panted Name Printed Name 3050 Fite Circle,Str 112 1 liter HDPE 4 <br /> FirmSacto,Calif 95827 500 ml glass 5 <br /> F""' 916-362-8947 I Fx 362-0947 I Inter glass 6 <br /> Date/Time DateCTime 2x6 sls ring 7 <br /> glassjar 8 <br />