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CHAIN OF CUSTODY/ LABORAIWY ANALYSIS REQUEST FO Page <br /> e g <br /> SHAW Env! mental&Infrastructure,Inc � <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order- #189246 for 2002 <br /> Project Name Don Rodgers Lab Sparser Technology <br /> Project Number 8800391A/01020000 Analyses Requested <br /> Report To Kathleen Waldo <br /> Company SHAW Environmental&Infrastructure,Inc <br /> Address 1325 N Market Blvd <br /> Sacramento,CA 95834 0 <br /> Dir Phone 961-565-4370/ F 16-565-4356 t U X <br /> L •/ M <br /> Sampler's Signature r <br /> F 3Q <br /> Z 1 U <br /> Sample REMARKS <br /> LA Samp a tedlar Container Types <br /> I D to Time I D Matrix n/a <br /> Preservations <br /> INFL �t 3n' AIR 1 X <br /> EFFLAIR I X <br /> LIN IED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTSREQUIREMENTSRE <br /> REQUIREMENTS X 1 Routine Report <br /> n?;wtcd <br /> S: nature <br /> Sign Signature g 24 hr 48 hr s day It Report(includes DUP,MS <br /> Na Panted Name Printed Name snndard(-tars ,r:aday,) MSD,as required,may be <br /> �� ft"fl eL Printed Name Provide Verhil PR[im�aary Results charged as samples) <br /> G f ftw4ePAX thelrm,nsryResults III Dam Validation Repon <br /> Firm Fi Ftrm Firm <br /> /yy Requested Report Dau (includes All Raw Data) <br /> e �/ RWQCB <br /> Datw TimeJB� jy�eLDatefTtme Z— Date/Time DatcTime <br /> RELIN U SHED BY RECEIVED BY Special Instructions/Comments (MDLs/PQLsfTRACC#) <br /> Container's ypes Ivey <br /> Signature Signature 40 nil VOA I <br /> Sparger Technology 125 ml LPI; 2 <br /> Panted Name Prtnwd Name <br /> 3050 Fite Circle Ste 112 ;00 ml Lpr 3 <br /> Sacramento,CA 95827 ] lila!{1)1'1 4 <br /> [F,,rn Firm <br /> 9168947 500 nil of iss ; <br /> fax-916.361-0947 I ]tic r glass 6 <br /> tcfIime DatefT... 3-5 sls ring 7 <br /> g]INS},r K <br />