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1 <br /> CALIFORNIA LABORATORY SERVICES 0 <br /> Page 1 of 8 0I/23/06 11 20 <br /> SHAW,E&i Inc (Sacramento) Project Parkinson's Arco,Stockton <br /> 1326 North Market Blvd Project Number 8800401A CLS Work Order# CPA0473 <br /> Sacramento,CA 95834 Project Manager Dan Wynne <br /> CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> Shaw Environmental&Infraslrurture,ire. /�f purchase Order 3649 for 2045' <br /> 1326 North Market Boulevard,Sacramento,CA 959M Mi� ` Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Anal stsPxquested <br /> Global ID 'IW 7700906 <br /> Project Number 8800401A <br /> Project Mnger Ilan Wynne aDan.Wynna@shawgrp.eom> 0 n Cq <br />' Company Shaw Environmental&Infrastructure,Inc 4 as <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95$3418 R Q <br /> Ihr Ph (916)5654184 f F (916)565 356 <br /> a W U <br /> Sampler's Slgnalure a ry REMARKS <br /> Sample LAB Sample t C-Types <br /> LD Date Time 1 D Matrix HQ Fnemvauom <br /> MW-1 1- 6 t Water 4 4 <br /> MW 2 Water 4 4 <br /> MW 3 Water 4 4 <br /> MW4 it( Waw 4 4 <br /> MW-5 st6 Water 4 1 4 <br /> I <br /> RELINQUISHED BY REC4'11VED BY RELINQUISHED Bi RECEIVED BY TURNAROUND REPORT REQUIRENIX M <br /> REQUIREMENTS X L Rootme Repast <br /> S Srpra m SeVtarare Signature 24 kr 41 hr say II Report fmchAcs DUP MS <br /> —9,3..0 er-rots--Z7..1 MSD as roqumat maybe <br /> N Pruned None Printed Natne Pnnted Name n-,-t vm-t rr-smr'vy Ruwe ChWFd as samples) <br /> r dk rue 1 Rnd. pill Data Valydmmrl Repon <br /> C• Fkrm Furn Firm ceq-:.ua Rep-D— 4mcludes All Raw Data) <br /> O <br /> RWQCR <br /> Dawrimel—J-7-06 0 Duornme Datefrime i}atdtlme 061DIa1`QLa/rRACEN) <br /> RELINQUISHED BY RECEIVED BY Sprual InstruetlaulCamrnents Cantatna Types Kxy- <br /> 40mlVOA I <br />' Sirau c S iQsxd[DDs Far GeoTracYer CES Labs 250 ml LPE 2 <br /> Dan.Wvnne44shaw¢2aCom 3249FitzgasklRoad 500m11PE 3 <br /> Pnnusl Name P Repomng limit Sppb fa MTBE Rancho Cardov&CA 93742 1 bra HDPE 4 <br /> 916.638&7301IFx 638.1510 500 m!Stast $ <br /> Firm Fitm y C*ww RayOslouskt I heerBlrw 6 <br />' V 2x6 r!t ns28 7 <br /> Datclrrrt,e Drmf1'uno . { e 8 <br /> • <br /> CA DOHS ELAP Accreditation/Registration Number 1233 <br /> 249 Fitzgerald Road Rancho Cordova, CA 95742 www.callfornialab.com 916-638-7301 Fax: 916-638-4510 <br />