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M Mir in M = M M M N M M M = 4r M <br /> CHAIN OF CUSTODY I LABORATO ANALYSIS REQUEST FORM <br /> Shaw Environmental&Infrastructure,Inc. Purchase Order 06 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab CLS Lab, <br /> Project Name Parkinson's Arco,Stockton Anal sis Requested <br /> Global ID• T0607700906 a <br /> Project Number 8800401A o a <br /> Project Manager David Herzog <br /> Company Shaw Environmental &Infrastructure,Inc l W N n <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 ¢ w <br /> Dir Ph (916)565.43771 FP <br /> (916)565.4 6 � <br /> W � U <br /> Samplers Signature � l Z REMARKS <br /> Sample LAB Sample �. I Container Types <br /> ID Date Time I D Matrix HCl <br /> Preservations <br /> MW-1 t- I`1 P4 Water 4 4 <br /> MW-2 Water 4 4 <br /> MW-3 Water 4 4 <br /> MW-4 1 Water 4 4 <br /> MW-5 se J%A%tV Water 4 4 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X L Routine Report <br /> Signa Signature Signature Signature 24 hr 4 hr 5 day R Report(includes DUP,MS <br /> X staMwd(-iai5wornm=days) MSD,as required,may be <br /> Pn aine' , Printed Name Printed Name Printed Name Provide Verbal Prehmmary Results charged as samples) <br /> �LL-W V tv Pramae FAX Prelimmary eesaiu M Data Validation Report <br /> Fumy/Q1149 ��. Firm Firm Firm Requested Report Date,o (includes All Raw Data) <br /> RWQCB <br /> Daterrime i--n-q— DatelTime Datelhme DatdTime (NIDLs/PQLsrIRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature igna Need EDDs for GeoTracker CLS Labs 250 ml LPE 2 <br /> David Herzog-@shawgrp com 3249 Fitzgerald Road 500 ink LPE 3 <br /> Printed Name Name Reporting hmit Sppb for MTBE Rancho Cordova,Ca 95742 1 hter HDPE 4 <br /> A�� 916-638.7341/Fz 6384510 500 a glass 5 � <br /> Firm Contact Ray Oslowski 1 hter glass 6} <br /> 2x6 s/s rmg 7 <br /> D.WTune DatelTirne —`i- is glass jar 8 <br /> rt <br />