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so - r M "M M an so � an r so w M <br /> [IAIN OF CUSTODY ! LABORA'I ANALYSIS REQUEST FORM <br /> Shaw E & I Inc.- 1326 North Market Houle%ard,Sacramento, CA 95834 Purchase Order #f 189246 for 2002' <br /> (916)928-3300 FAX (416)928-334.1 Lab Sar er Technology <br /> Project Name Dan Roger s Anal sts Requested <br /> Project Number 880031, IA/014IM1000 <br /> Project Manager Kathleen Walde N <br /> Company IT CORPORATION r <br /> Address 1326 North Nfarket Boulevard � <br /> 4 <br /> Sacramento,CA 95834 U <br /> Phone 916-5654370 / FAX 916-5654356 <br /> Sampler's Signature - �� x <br /> zI I IREMARKS <br /> Sample LAB Sample lContamer Types <br /> I D Date rinie I D Matrix Tedlar Preservations <br /> Intl 1 o d 0&D Air l 1 <br /> Ef I Air l 1 <br /> I } <br /> RELINQUISHED BY RE '4IVED BY RELIN 111sHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> St C.� Sign t4u r tgnature 5t 2a nr a8 hr s day II Report(includes DUP,MS <br /> X Standard(10 15 worlang days) MSD,as required-may be <br /> Pnnted Name Pnmed Name Printed Nang Printed Name Provide Verbal Prelnnmery Results charged as samples) <br /> Tim R Wngltt � Prnvtde FAX Prebm my Results III Data Validation Report <br /> Finn Fimi FirmFii� I/ Qz r O Requested Report part RW CBdes Raw ata) <br /> Shaw E&,I Inc Jf l� <br /> Date/nine G IL I a s Ac Date/Time Daterfune (MDL-JPQLs/TRACE#E) <br /> RELIN UI LIED i}1 RECEIVED BY Specie[ Container Container Types Kay <br /> 44 ml VOA 1 <br /> Signature Sigttat:rte 125 nil LPE 2 <br /> Sparger Tech. 500 ml LPE 3 <br /> Pnnted Name PrinlLd Nance 3030 Fite Ude,Ste,112 1 liter HDPE 4 <br /> Sacto calif 95827 500 ml glass 5 <br /> Firm Finn 916.362.89471 Fa 362-0947 1 liter glass 6 <br /> 2x6 us nng 7 <br /> I7aterItme Dal. i une I 1m ai 8 <br />