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0 CHAIN OF CUSTODY/LABORAT ANALYSIS REQUEST FORM <br /> Straw Environmental&Infrastructure,Inc. Purchase Order 2T[S4AfflL 06765 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Anal sis Requested <br /> Global ID: T0607700906 0 <br /> Project Number 8800401A/01060000 0 <br /> Project Manager David Herzog e <br /> Company Shaw Environmental&Infrastructure,Inc00 00 <br /> Address 1326 North Market Boulevard 0 X <br /> Sacramento,CA 95834 w <br /> Dir Ph (916)565-4377/ F (916)56 4356 A <br /> Sampler's Signature <br /> x <br /> Z I H I IREMARKS <br /> Sample LAB Sample "` I Contamer Types <br /> 1 D Date Time l D Matrix " HCI Preservations <br /> MW-11.12 10101 Water 4 4 <br /> MW-2 i PA4 Water 4 4 <br /> MW-3 Water 4 4 <br /> MW4 Water 4 4 <br /> MW-5 Water 4 4 <br /> i <br /> I <br /> RELINUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENT'S <br /> REQUIREMENTS X I Routine Report <br /> SigAf <br /> Si Signature Signature 24 hr 48 hr i day 11 Report(includes DUP,MS <br /> X Standard(-10 15 wnrlang days) MSD,as required,may be <br /> Print ame ,� V P ed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> [ H (4f rle/ Provide FAX Prehmmary Results III Data Validation Report <br /> Firm Firm CLt Firm Firm Requested Report Date (lBdes All Raw Data) <br /> RW <br /> Date/Time /'J Date/Time I-Jq-03 63g DatelTime Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 mf VOA 1 <br /> Signature Signature Need EDDs for GeoTracker CLS Labs 250 ml LPE 2 <br /> 3249 Fitzgerald Road 500 nil LPE 3 <br /> Printed Name Printed Name Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> 916-638-7301/Fx 638-4510 500 ml glass 5 <br /> Film Finn Contact Rav Oslowskl 1 liter glass 6 <br /> 2x6 sls ring 7 <br /> [73te/Time Date/Time glassiar 8 <br />