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i4r � <br /> N CHAIN OF CUSTODY I LABORATW ANALYSIS REQUEST FORM <br /> g SHAW Environmental&Infrastructure,IDc. Purchase Order 93648 <br /> 1326 North Market Boulevard S ramento,CA 95834 Lab STL l Quanterra,W.Sacto - <br /> Project Name.Don Rodgers Analysis R nested <br /> Global m: 70607700717 <br /> ProjectNumber 9800391A/01010000 <br /> Project Manager- Daft Wynne 9 ,. <br /> Company. SHAW Environmental&Infrastructure,Inc g <br /> Address 1326 North Market Boulevard V° <br /> Sacramento,CA 95834 <+ <br /> Dir Ph 91.6-565.4184 / FAX 916-5 4356 1. <br /> x <br /> Sampler's Signature. z M REMARKS <br /> Sample LAB Sample 1 Coatmner Types <br /> I,D Date Time ID Matrix iiGl Preservations <br /> MW-1R E3-cl W water 3 3 <br /> MW-2RC} water 3 3 <br /> MW-3R water 3 3 <br /> MW-4RS 8 water 3 3 <br /> MW-4RD water 3 3 <br /> o VW-11) `1i�' water 3 3 <br /> m <br /> VW-21) "�y3 water 3 3 <br /> VW-3D 3S water 3 3 <br /> VW-4 pp t water 3 3 <br /> S <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routmo Report <br /> Sig re Sr Slgnattac Signature 2i hr _4s hr _5&y 11 Report(includes DUP,MS <br /> X $iwWwd(-10-15 wark,ng days) MSD,as required,may be <br /> Prip Name Mame PnotW Name Printed Name Fmvidc Vestal Fral msnry Rcstdu charged as samples) <br /> Prao&FAX Fr4minwy Rmlis III Data Validation Report <br /> FumFirm Firm Rsgacsud Rport eDar (includes All Raw Data) <br /> C � <br /> RWQCB <br /> Date fame _p Date/Time ,` Date/Itme DateJl ime (MDLs/MLs1TRACE#) <br /> RELINQUISHED BY RFLMVhU B T Special Instructlons/Comments, Container Types Key <br /> 40 int VOA 1 <br /> Signature Sigmture STL/Quantem 125 ml LPE 2 <br /> Need EDDs for GeoTracker. 890 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Printed Name Send directly to: tsusan.waterman@shawgrp.coM> W Saoto,Calif 95604 1 literHDPE 4 <br /> 916-373-56401 Fx 372-1059 500 ml glass 5 <br /> Finn Firm Contact Jon Gildersleeve 1 liter glass 6 <br /> 2x6 s/s rmg 7 <br /> A <br /> Date me Date Time Fteld Coord Sheila 916-5654327 glass Jar 8 � <br /> X <br /> w <br /> N <br />