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CHAIN OF CUSTODY/ LABORAT04 ANALYSES REQUEST FORM <br /> Shaw Environmental&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab CLS Labs <br /> FGIobal <br /> ct Name Parkinson's Arco,Stockton An sis Requested <br /> ID• T0607700906 <br /> t Number 8800401Aroject Manager David Herzog <br /> Company Shaw Environmental&Infrastructure,Inc cc <br /> Address 1326 North Market Boulevard �? X A <br /> Sacramento,CA 95834 <br /> Dir Ph (916)565-43771 FA - 365 ,- Q <br /> Sampler's Signature ' ¢ 0 <br /> E~ REMARKS <br /> Sample LAB ample lContainer s <br /> ID D to Time I D Matrix HC[ Preservations <br /> MW-1 p/1', 010 Water 4 4 <br /> MW-2 V 7ff Water 4 4 <br /> MW-3 Water 4 4 <br /> MW-4 074 1 Water 4 4 <br /> MW-5 L Water 4 4 <br /> i <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sl Signature Signature Signature as hr 4a hr -5day II Report(includes DUP,MS <br /> X Sundard(-10-15 working days) MSD,as required,may be <br /> PrtnyC{��Iame �t Printed Name Printed Name Printed Name Provide Verbal Preliminary Raults charged as samples) <br /> Provide FAXPrelrmmary Results III Data Validation Report <br /> Firm Ili Firm Firm Firm Requeamd Rapon Dam (includes All Raw Data) <br /> .�� RWQCB <br /> DateJTune foalJOatemme Date/time Datefrime (MDLs/PQLs/TRACE#) <br /> RELINQUISHED Bt RECEIVED BY Special Instructions/Comments Contamer Types Key <br /> 40 ml VOA i <br /> Signature Si nature Need EDDs for GeoTracker CIS Labs 250 ml LPE 2 <br /> Dai id I 1crzog@shawgM com 3249 Fitzgerald Road 500 ml LPE 3 <br /> Prated Name rite am Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE <br /> 916-638.7301/fx 6384510 500 ml glass 5 <br /> Finn Firm Contact Ray Oslowski l liter glass F <br /> 2x6 s/s ring 7 <br /> Dateltune Date/Time 7!- glass far 8 i <br />