Laserfiche WebLink
CHAIN OF CUSTODY/LABORATORY .ANALYSIS REQUEST FORM <br /> Shaw Environmental&infrastructure,Inc. Purchase Order. 206165. <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab: CLS Labs <br /> Project Name:Parkinson's Arco,Stockton Analysis Requested <br /> Global ID: 70607700906 <br /> Project Number: 8800401A/01060000 y o <br /> Project Manager: David Herzog7-F I <br /> o <br /> Company: Shaw Environmental&Infrastructure,Inc. <br /> Address: 1326 North Market Boulevard 0 x w <br /> JS <br /> Sacramento,CA 95834 w p ¢ <br /> Dir Ph: (916)565-4367/ F (916)56�4 Q �O <br /> Sampler's Signature: Z REMARKS <br /> Sample LAB Sample 1 <br /> Container Types <br /> I.D. Date Time I.D. Matrix HCl Preservations <br /> MW-1 f G /3 Water 4 4 <br /> MW-2 Water 4 4 <br /> MW-3Water 4 4 <br /> MW-4 Water 4 4 <br /> MW-5 Ly3D Water 4 4 <br /> RELINQ HED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si Signature Signature Signature 24 hr 49 hr _5 day Il. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Print a Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> M Provide FAX Preliminary Results III.Data Validation Report <br /> Finn L"_) <br /> Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> RWQCB <br /> Date/Time Date/I'ime Date/Time Date/I'ime (MDLs/PQLs/TRACF4) <br /> RELINOU19HED BY RE C IVED BY Special Instructions/Comments: Container Types Key: <br /> 40 ml VOA: 1 <br /> Signature Siva6rl <br /> Need EDDs for Gedfracker. CLS Labs. 250 ml LPE: 2 <br /> ` I Z 3249 Fitzgerald Road 500 ml LPE: 3 <br /> Printed Name Printe�ame S Reporting limit 5ppb for MTBE. Rancho Cordova,Ca 95742 1 liter HDPE: 4 <br /> O� o-wr 916-638-7301AFx:638-4510 500 ml glass: 5 <br /> Firm Firm GLS Contact: Ray Osfawski 1 liter glass: 6 <br /> Dat2x6 s/s ring: 7 <br /> e/Cime N Date/time j -1 _� f glass p <br />