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r r�r nr �r r� r rr � r r r �• <br /> CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Rm&vnmental&Infrastructure,Inc. Purchase mer. 3648 <br /> 1326 North Market Bonleva Sacramento CA 95834 - Lab STI./ terra,W.Sacto <br /> RvUea Name.Don Rodgers Ansi is R ested <br /> Global ID: T0607 M717 <br /> Project Nmnbw 8800391A/01010000 <br /> protect Manager Dan Wynne <br /> Company: SHAW Environmental&Infrastructure,Inc. <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 5$34 0 <br /> Dir Ph: 916-565-4184 / 916-5 4300 <br /> .. <br /> RE KA kO <br /> Sampier s Signature <br /> sampleLAB Semple <br /> LD Date <br /> Time LD Matrix HCI <br /> MW-IR i�+ �`� water 3t 3 T;st t r r a ts� T <br /> t wales 3- 3 �. � U+1 .�3�;, ;� <br /> MW-2R _ <br /> MW-3R f water 3 3 <br /> MW�4RS wales 3 3 <br /> MW-4RD 8" water 3 3 <br /> VW-ID water 3 3 I I <br /> VW-21) q* water 3 3 <br /> VW-31) Ct* water 3 3 <br /> VW-4 water 3 3 _ <br /> LRS B , RE BY REI�1QEl D BY RECEIVED BY TMNAROUND RMRT R�QUOtF11�MS <br /> RBQUBUMENn X L Routine Repmt <br /> Signaun: SWAM24fQ ss hr Idly 1L Report(ittdndea DiTP,IvLS <br /> tV��K smma(-rarswmx�saar f MSD,as ro9=ed.nay be <br /> Name Punted Name Printed Name Printed Name rrorldFve�trnem�dmryRxeha chargadus samples} <br /> a" �. 60---C-0-0ger t t� M.Data vandadm Repart <br /> �p oR � Fim1 Firm Rwpmmd RgPM DNc Gndudas Ali Raw Data) <br /> RWQCB <br /> Daterilme '3 Datd[rme R Dater = DateMm } <br /> RBLIl�iQULS1IFD BY RECEIVED BY Specht Ittsmnederwcomnm". Com��ROY <br /> 40 m1 VOA. 1 <br /> S�aaer� Sri S'1L f Quante 125m1 LPE. 2 <br /> Need EDDs for GeoTracker 990 Rmmde Pad-way 500 101 LPS 3 <br /> 1'nntad Norm Name Report to the PIL in PDF format,please. W Sacto,Cahf 95%04 1 tetra HDPL 4 <br /> Dan.Wynne@shawgrg cans 916-373.56041 hat 3721059 500 1111 glass: 5 <br /> Frim rxn Contact: Jon Gildersleeve 1 hwglaas 6 1 <br /> 2x6 sts nrg 7 <br /> glen* S <br />