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CHAIN OF CUSTODY l LABORS JRY ANALYSIS REQUEST FORM <br /> SHAW E. _,onmental& Infrastructure,Inc Purchase Order #189246 for 2002' <br /> (Formerly IT Corp)- 1326 North Market Boulevard,Sacramento,CA 95834 Lab Sparger Technology <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01030000 <br /> Project Manager Kathleen Waldo <br /> Company SHAW Environmental&Infrastructure,Inc, <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 0 <br /> Phone 916-565-4370 1 FAX16-565-4356,, v <br /> Sampler's Signature 0 x <br /> REMARKS <br /> ample LAB gain-pie i Container Types <br /> I D Date Time I D Matrix Tedlar Preservations <br /> Infl e� C Air 1 1 <br /> I <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> 0REQUIREMENTS X I Routme Report <br /> gnaw Seg to Signature Signature 24 hr 48 hr 5 day 11 Report(includes DUP,MS <br /> SdsTd -141s working days} MSD,as required,may be <br /> PnName UPrinted Nam Panted Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Prayide FAX Prelemmary Results III Data Validation Report <br /> Ft l Firm p Firm Finn ReyuaudReport Date (includes Al!Raw Data) <br /> RWQCB <br /> DatelTlme JC DaW Tune p_p py f une Dakj7une (MDLs&QLsrFRACF4) <br /> RELL44QIISHED BY RYCEWED BY Special Instructtons/Commeats Cosntmr er Types Key <br /> 40 ml VOA 1 <br /> Signature Signature 125 ml LPE 2 <br /> Sparger Tech 500 ml LPE 3 <br /> Printed Name Printed Name 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> Sacto,Calif 95827 5005 <br /> Farm Firm 416-362-8947!Fx 362-0947 1 't 6 <br /> nn� ? <br /> Datefl'une Date/tune �� � � � _ <br />