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k CHAIN OF CUSTODY/LABORAT .Y ANALYSIS REQUEST FORM .- <br /> Shaw Environmental&Infrastructure,Inc. $ Purchase Order: 206765 i <br /> 1326 North Market Boulevard Sacramento CA 95834 Lalli CLS Labs <br /> Project Name: Parkinson's Arco,Stockt6n Anal sis Requested <br /> Global ID: T0607700906 c <br /> Project Number: 8800401A/01060000 0 <br /> Project Manager: David Herzog w o <br /> Company: Shaw Environmental& Infrastructure,Inc. S 00 <br /> Address: 1326 North Market Boulevard a T <br /> Sacramento,CA 95834 4. <br /> Dir Ph: (916)565-43671 F (916)56(4 Q H <br /> Q 1 <br /> Sampler's Signature: <br /> Z REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I.D. Date Time I.D. Matrix ; HCI Preservations <br /> MW-1 f 0//)A!; Water 4 4 <br /> MW-2 Water 4 4 <br /> MW-3 Water 4 4 <br /> MW-4 Water 4 4 <br /> MW-5 Water 4 4 <br /> Il <br /> RELINQ HED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIRENIENTS <br /> REQUIREMENTS i X 1. Routine Report <br /> Si Signature Signature Signature 24 hr _48 hr 5 day II. Report(includes DUP,MS <br /> X standard(–ID-15 working days) MSD,as required,may be <br /> Print J Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> f Provide FAX Preliminary Results III.Data Validation Report <br /> Fi Firm Firm Firm RequesledRep-tDare: (includes All Raw Data) <br /> HMDLs/PQLsII'RACE#) <br /> WQCB <br /> Date/Time Datelrime Date/Time Date/Time <br /> RELF1; UI H9D BY RE IVED BY Special Instructions/Comments. Container Types Key: <br /> 40 tel VOA: I <br /> ` Signature SiUM6, ( Need EDDs for GeoTracker. CLS Labs 250 ml LPE: 2 <br /> 9 3249 Fitzgerald Road 500 ral LPE: 3 <br /> i <br /> Printed NamePrime ame f Reporting limit 5ppb for MTBE: Rancho Cordova,Ca 95742 1 liter HDPE: . 4 <br /> ,2aN�S �a.,d 916-638-7301/Fx:638-4510 500 nit glass: 5 <br /> Firm Firm G L Contact: Ray Oslowski l liter glass: 6 <br /> 2x6 s/s ring: 7 <br /> Date/Time I)ateC£ime J -! ^D J � � � glass jar- g <br />