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m- roro M M an M_ M .r re r so r M M M m e W <br /> CHAIN OF�CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM V <br /> HAW Enrvironmentai&Infrastructure,Inc. Purchase Order #3648 <br /> 1326 North Market Boulevar Sacramento CA 95834 - - ~' Lab STL/Quanterra,W.Sacto <br /> Project Name Don Rodgers An is Requested <br /> Global ID: 70607700717 <br /> Project Number 8800391A/01010000 <br /> Project Manager: Dan Wynne <br /> Company- SHAW Environmental&Infrastructure,Inc. <br /> A idre* 1326 North Market Boulevard <br /> +� Sacramento,CA 95834 <br /> D>irPh:_ :916-565-418_3 ! FAX: - 916-Sb54 6_ <br /> •, •� i.` els': d��a�gug ' >' •u•, ` <br /> ...a..,;�.�.C.n^- -t.. �� I' - i.aZ - 1 f �♦ �'1�'111.L\.11.] <br /> t �� *� e •_i _ ! > Contamer Types <br /> -Matnx HCl - Preservations <br /> water 3 3 <br /> -2R= y3 r a- water 3 3 <br /> - - <br /> =ter." 3 3 - <br /> 3" <br /> 3" 3 4 <br /> RD <br /> 3 3 a <br /> =�� q <br /> 1&4 <br /> -tD Y water 3 3 r; <br /> 3 3 <br /> 4 f <br /> ' W-4 water 3 3 i <br /> IIVQUISFIED BY _RECEIVED BY =' RELINQUISHED BY w = -RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> , _ _ ` REQUIREMENTS X 1 Routine Report <br /> Will Signa Sigiiatur G Signature 24 hr + 49 hr ' 5 day I I Report jincludes DUP,MS <br /> ' X suaeer8(-io is B days) MSD,as mquwcd,may be+ <br /> prm Pnnted Name a - Printed Name Printed Name protide V&W Mimmffy RelWa charged as samples) <br /> L Q C �L Y[�4r, ProvideFAX rnaun,aary ttnnlcs ill Data Validation Report <br /> Finn Finn _4SSL Firm Firm R«q�ca Rem Da,� (includes All Raw Data) <br /> Err ✓T RWQCB <br /> Daterrimet!'7-c- Daterrime o (41_5 Datw7ime Daterrime (MDLsIPQLsfiRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA l <br /> Signature Signature STL I Quantena 125 ml LPE 2 <br /> Need EDDs for GeoTracker. 880 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Pnnted Name Send directly to: <susan Waterman@shawgrp.eom> w Sacto.Calif 95604 1 liter HDPE 4 <br /> 916-373-56001 Fv 372-1059 500 ml glass 5 <br /> Firm Firm Contact. Ptavani Pillay - I liter glass 6 <br /> 2x6 sts nng 7 <br /> Datefrime Date/Time iFieldCoord Sheila @916-5654327 glass jar 8 <br /> I ' <br />