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M M CRIAN CM'OI"LA"RgR?%AM1IS MUS ' FO'RM <br /> Shaw En mental&Infrastructure,Inc - x <br /> Purchase Order 192121 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab CLS Labs <br /> .Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Project Number 880-040 1A/01060000 <br /> Project Manager Kathleen Waldo 0 <br /> o <br /> Company Shaw Environmental&Infrastructure,Inc W <br /> Address 1326 North Market Boulevard c <br /> Sacramento, CA 95834 0 00 <br /> Dir Ph ( <br /> (9I6) 565-4370 / FAX (916}565-435 ,U W <br /> E� <br /> Sampler's Signature (j w <br /> � x � <br /> REMARKS <br /> Sample P LAB Sample l Container Iypes <br /> I D Date Time I D Matrix HCl Preservations <br /> MW-1 Water 4 4 <br /> MW-2 '11Gfi 1 Water 4 4 <br /> MW-3 I 113L Water 4 4 <br /> MW-4 �— Water 4 4 <br /> MW-5 / Water 4 4 <br /> I2ELINQUIS D BY RECEIVE BY RELINQUISHED BY RECEIVED BY TURgAROU" REPORT REQUIREMENTS <br /> Signature Sign REQUIREMENTS X I Routine Report <br /> g Signature Signature 24 hr 48 hT s day II Report(includes DIJP,MS <br /> w/kicivh'- C7 Standard(-10 15 working days) MSD,as required,may be <br /> Printed Vie. Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide PAX Pr4mmary Results III Data Validation Report <br /> Finn CQL� I I J Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> RWQCB <br /> Date/Ttme - jjl Date/Time ZkWO2 ate/Time Date/Time WLs/PQ1,sn`RACE#) <br /> RELINQUISHED BY REqEMD BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature Need EDDs as required by the RWQCB CLS Labs 250 ml LPE 2 <br /> 3249 Fitzgerald Road 500 ml LPE 3 <br /> PrmtedName 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 /> Firm Firm Contact Ray Oslowski I liter glass 6 <br /> Date/Time2x6 s/s ring 7 <br /> Date/I'urie <br /> glass Jar 8 <br />