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M � Ir M M <br /> m M M M = 4r M <br /> CHAIN OF CUSTODY/LABORAY <br /> ANALYSIS REQUEST FORM <br /> SHAW Environmental& Infrastructure,Inc, Purchase Order 3648 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab STL 1 Quanterra,W.Sacto <br /> pro <br /> 3ect Name Don Rodgers Aiialysis Requested <br /> Global <br /> ID T0607700717 <br /> Project Number 8800391A/01010000 <br /> Project Manager David Herzog <br /> Company SHAW Environmental&Infrastructure,Inc o <br /> Address 1326 North Market Boulevard � <br /> Sacramento,CA 95834 c c <br /> Dir Ph 916-565-4377 / FAAX 916-,56 356 4, <br /> .n <br /> c7 X <br /> E x w <br /> Sampler's Signature m REMARKS <br /> Sample - LAB Sample 1 Contama Types <br /> I D Date Time I D Matnx HCl Preservations <br /> MW-IR I, -1j �1water 3 3 , <br /> i <br /> MW-2R water 3 3 <br /> MW-3R water 3 3 <br /> MSV-4RSZ- water 3 3 <br /> MW4RD ��$ water 3 3 <br /> VW-113 water 3 3 <br /> VW-213 Q water 3 3 <br /> VW-31) 4 Cts water 3 3 <br /> VW-4 t7 water 3 3 <br /> y r f <br /> RELINQMSHED 13Y RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> $igna> Signature Signature 24 hr 48 hr s day U Report(includes DUP,MS <br /> xW LLA <br /> X Snadard(—I0.E5 welling days) MSD,as required,may be <br /> PnndMame *nnNZame Printed Name Printed Name Provide Verbal Fninnimry Results charged as samples) " <br /> ` N / Prondc FAX mltm nuy Results III Data Validailon Report <br /> Firm Firm Firm Finn RequesedReportDate (includes All Raw Dazs) <br /> 57Z—'r'� RWQCB <br /> DatrlTimel ly--C Dfl ime ISS- ! Date/Time Date/Time (MDLs/PQLs/T RACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types trey <br /> - 40 nil VOA 1 <br /> SEgnature St-nature STL/Quanterra 125 ml LP1- 2 <br /> Need EDDs for GeoTracker 880 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Pnnted Name Report to the P M in PDF forma, please W Sacto,Calif 95604 t liter HDPE 4 <br /> David Hcrzog@Shawarp corn 916-373-.)600/Fx 372 1059 50')ml glass <br /> Finn Finn Contact Son Gildersleeve ` I liter glass 6 <br /> 2x6 s/s ting 7 <br /> Date/Time DatefTi rL f stass jar 8 <br />