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MW = M MM M M M M O?C?#'A <br /> CHAIN OF CUSTODY /LABORAVY ANALYSIS REQUEST FORM 0 <br /> Shaw EQvironment .1&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab CIS Labs <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> GloballD T0607700906 <br /> Project Number 880040ZA/01060000 0 <br /> Project Manager David Herzog �w <br /> Company Shaw Environmental&Infrastructure,Inc W N <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 <br /> Dir Ph (916)565-43F/ 1~ (916)565-4 56 <br /> Sampler's Signature REMARKS <br /> Sample LAB Sample I lContainer Types <br /> I D Date Time ID Matrix ;' <br /> HCl Preservattons <br /> MW-I 3( Water 4 4 <br /> MW-2 -57 Water 4 4 <br /> MW-3 Aei Water 4 4 <br /> MW-4 l $ Water 4 4 <br /> MW-5 Water 4 4 <br /> V <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signa Signature Signature Signature 24 hr 48 hr 5 day lI Report(includes DUP,MS <br /> X Standard(-1015 working days) MSD,as required,may be <br /> PqJ, ame Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> � CIA D Provide FAX Preliminary Results III Data Validation Report <br /> G ►►►{{{ t Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature S Need EDDs for GeoTracker CLS Labs 250 ml LPE 2 <br /> 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name Printe a Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> L G 916-638-730I/l:x 6384510 500 ml glass 5 <br /> Firm Firm / lr L Contact RayOslowsk[ I liter glass 6 <br /> [� 7 2x6 sls ring7 <br /> DatelFcme Daterfune _9 glassjar 8 <br /> If 14 n <br />